UC-NRLF 


B    3    ID?    ShE 


GS? 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


ON 

THE   MEDICAL    PROPERTIES 

DUPLICATE 

THE  NATURAL  ORDER 

RANUNCULACEJE; 

AND   MORE    PARTICULARLY  ON  THE 

USES  OF  SABADILLA  SEEDS,  DELPHINIUM  STAPHISAGRIA, 
AND  ACONITUM  NAPELLUS, 

/ 

AND    THEIR   AtCALOIOS, 

VERATRIA,    SABADILLINE,    DELPHINIA,   AND 
ACONITINE. 


BY   Al^TURNBULL,   M.D. 


PHILADELPHIA: 
HASWELL,  BARRINGTON,  AND   HASWELL. 

1838. 


PREFACE. 


THE  greater  part  of  the  contents  of  the  following  pages 
has  been  already  laid  before  the  profession,  and  the  object 
the  author  has  in  view  at  present,  is  to  give  a  connected 
account  of  the  new  medical  properties,  which  he  conceives 
to  reside  in  many  of  the  plants  belonging  to  the  natural 
order  Ranunculacea,  and  more  particularly  as  they  are 
found  in  Sabadilla  seeds,  in  the  seeds  of  the  Delphinium 
Staphisagria,  and  in  the  root  of  several  species  of  the  genus 
Aconitum.  The  properties  alluded  to,  are  those  possessed 
by  preparations  of  the  plants  above  mentioned,  when  ad- 
ministered internally,  of  exciting  sensations  of  heat  and 
tingling  on  the  surface  of  the  body,  and  of  producing  similar 
effects  locally  when  rubbed  upon  the  skin,  without,  in  most 
instances,  giving  rise  to  irritation  of  the  vascular  system; 
and  when  exhibited  in  either  way  in  certain  painful  diseases, 
as  Neuralgia,  Rheumatism,  and  Gout,  of  alleviating  or 
removing  the  pain,  apparently  by  exerting  a  peculiar  effect 
upon  the  nervous  system,  unattended  by  any  narcotic 
influence. 

These  effects  are  more  certain  and  exist  in  a  higher 
degree  of  energy  in  the  active  principles  obtained  from  the 
plants,  arid  on  this  account  the  author  has  bestowed  more 
attention  on  them,  and,  in  most  cases,  would  give  them 
the  preference  as  medicinal  agents.  He  has  also  dwelt 
more  fully  upon  the  effects  produced  by  them  when  ap- 
plied to  the  surface,  than  when  exhibited  internally,  because 
experience  has  shown,  that  by  the  former  method,  a  quan- 


4  PREFACE. 

tity  sufficient  to  remove  disease  may  be  introduced  into 
the  system,  whilst  at  the  same  time,  in  topical  affections  the 
remedy  may  in  this  manner  be  applied  over  the  seat  of 
the  disease ;  but  when  the  affection  is  more  general  in  its 
character,  the  internal  use,  or  both  methods  combined, 
will  be  found  most  advantageous. 

The  author  would  caution  the  profession  against  expect- 
ing too  much  from  the  employment  of  these  remedies.  In 
some  cases  they  have  given  only  a  temporary  relief,  whilst 
in  others  they  have  had  no  effect:  but  generally  speaking 
he  has  found  them  of  much  more  advantage  in  the  treat- 
ment of  a  very  distressing  class  of  affections,  than  any  means 
hitherto  discovered,  and  on  this  account  he  would  recom- 
mend their  use. 


Russell  Square,  June  1st,  1835. 


CONTENTS. 


PAGE 

Introduction  .     .  7 


CHAPTER  I. 

Medicinal  Properties  of  Sabadilla  Seeds 9 

Preparation  ofVeratria 10 

Internal  Administration  of  Veratria  and  its  Salts 11 

External  Application  of  Veratria 15 

in  Affections   of  the   Heart 17 

in   Neuralgic  Affections 27 

in  Rheumatism 37 

in   Gout 42 

in  Dropsy  and  Paralysis 44 

Properties  of  the  Constituents  of  the  Veratria  of  Commerce,  viz : 
Veratrine,    Veratrin,  Sabadittine,  Mono-hydrate  of  Sabadilline  .  47 


CHAPTER  II. 

Medicinal  Employment  of  Delphinium  Staphisagria,  and  its  Active 

Principle    Delphinia      > 48 

Preparation  of  Delphinia 49 

Internal  Administration  of  Delphinia  and  its  Salts 50 

External  Application  of  Delphinia 50 


CONTENTS. 


CHAPTER  III. 

PAGE 

Medicinal  Employment  of  the  Genus   Aconitum,  and   its   Active 

Principle   Aconitine 53 

Processes  for  preparing  Aconitine 55 

External  Application  of  Aconitine 56 

of  Ammoniated  Extract  of  Aconite 59 

Severe  Case  of  Neuralgia  of  the  Finger,  cured  by  Preparations  of 

Aconite ,:,;•,   •  60 

St.  Thomas's  Hospital  Report 66 

Appendix — Cases  communicated  to  the  Author 69 


ON  THE  MEDICAL  PROPERTIES 


OF    THE    KATURAL    ORDER 


RANUNCULACE^; 


AXD    OF    THE    ALCALOIDS, 


VERATRIA,  SABADILLINE,  DELPHINIA,  AND  ACONITINE. 


OF  the  three  plants,  whose  medicinal  properties  it  is  intended  to 
give  an  account  of  in  the  following  pages,  two,  the  Delphinium 
Slaphisagria  and  the  Jiconitum  Napellus,  belong  to  the  extensive 
family  ranunculacese ;  and  with  regard  to  the  third,  the  plant 
which  yields  the  Sabadilla  seeds,  little  appears  to  be  known,  by 
which  its  precise  character  and  situation  in  botanical  arrangements 
can  be  determined.  It  has  been  supposed  to  belong  to  the  class 
ColchicacesSy  but  as  in  some  of  its  medicinal  properties  it  is  much 
more  allied  to  the  ranunculacese y  it  is  intended,  for  the  sake  of  con- 
venience, to  speak  of  it  as  belonging  to  this  latter  class,  until  our 
knowledge  of  it  becomes  more  definite. 

The  natural  family  ranunculacese,  as  a  whole,  exhibits  consider- 
able uniformity  ;  but  nevertheless,  some  discrepancy  occurs  when 
its  parts  are  more  minutely  examined.  Many  of  the  individuals 
are  acrid  and  caustic  in  the  highest  degree,  whilst  others  are  aromatic, 
as  the  Nigella  Sativa,  which  in  consequence  of  its  taste  is  some- 
times used  as  a  pepper.  In  some  again,  the  properties  they  possess 
are  owing  to  an  active  principle  which  can  be  separated  by  che- 
mical processes  ;  whilst  in  others,  as  for  instance,  in  almost  the 
whole  tribe  of  ranunculuses,  these  are  destroyed  by  drying  and 
boiling,  or  even  by  simple  infusion  in  water,  whilst  they  are  aug- 
mented by  acids,  honey,  sugar,  wine,  alcohol,  &c.*  The  acrid  Cle- 
matis Vitalba  is  used  as  an  article  of  food  after  being  boiled,  by 
the  country  people  in  the  north  of  Italy,  and  the  Ranunculus 
aquaticus  is  sometimes  given  to  cattle  after  being  deprived  of  its 
acrimony  by  drying.  The  general  properties  of  the  family  may  be 

*  Decandolle  Essai  sur  les  Proprietes  Medicales  des  Plantes. 


8  TURNBULL  ON  RANUNCULACE.E, 

thus  stated  ;  Acrid  and  vesicatory,  e.  g.  many  of  the  ranunculuses, 
Clematis  recta,  Knowltonia  Vesicatoria,  &c.,  which  are  used  as 
blisters.  Acrid,  stimulant,  cathartic,  emetic,  e.  g.  the  roots  of  dif- 
ferent species  of  Hellebore,  Delphinium  Staphisagria,  &c.  Bit- 
ter, tonic,  antispasmodic,  e,  g.  Zanthoriza  apufolia,  Hydrastis 
Canadensis,  Pxonia  officinalis.  Along  with  the  acrid  prin- 
ciple there  exists  a  powerful  narcotic  property  in  the  Aconites  ; 
some  of  the  acrid  plants,  as  the  Ranunculus  Glacialis,  are  sudorofic, 
and  others  are  diuretic  and  vermifuge. 

In  addition  to  these,  there  is  another  class  of  properties,  which  exists 
in  the  Delphinium  S tap  his  a  grid,  some  species  of  the  Aconites,  and 
in  the  Sabadilla  seeds,  and  in  a  more  marked  degree  in  the  alca- 
loids  prepared  from  these  plants  ;  namely,  the  Delphinia,  Aconi- 
tine,  and  Veratria  ;  and  there  can  be  little  doubt,  that  further  inves- 
tigation into  the  medicinal  action  of  the  ranunculacese,  will  in- 
crease the  number  of  the  individual  plants  which  possess  such 
properties. 

When  preparations  of  the  species  above  mentioned,  or  their  alca- 
loids,  are  exhibited  internally  in  small  and  repeated  doses,  they  give 
rise  to  peculiar  effects  on  the  nervous  system,  but  more  particularly 
upon  the  nerves  of  sensation.  These  consist  of  heat,  and  tingling 
on  the  surface  of  the  skin,  beginning  generally  in  the  extremities, 
and  extending  themselves  towards  the  trunk  and  head,  and  some- 
times ending  in  perspiration  ;  and  in  rheumatic  and  other  painful 
affections,  these  sensations  are  attended  by  marked  relief  to  the 
patient.  The  same  effects  are  produced,  but  more  locally,  when 
the  active  principles  and  other  preparations  of  the  plants  are  applied 
by  friction  over  the  seat  of  the  disease  ;  heat  and  tingling  are  like- 
wise induced  ;  at  first  only  in  the  part  where  the  friction  has  been 
made,  but  afterwards  extending  itself  over  the  skin.  In  affections 
which  are  topical  in  their  nature,  these  peculiar  feelings  are  also 
attended  by  great  diminution  in  the  severity  of  the  symptoms,  and 
often  by  a  removal  of  them  after  every  other  means  have  failed. 

It  would  be  an  interesting  question,  to  determine  in  what,  manner 
such  effects  are  produced  :  but  as  yet  nothing  has  been  made  out, 
that  is  calculated  to  throw  light  upon  the  subject.  All  that  can  be 
said,  is,  that  they  are  matters  of  observation,  and  it  is  quite  sufficient 
for  the  purpose  of  the  practitioner  that  they  are  so,  for  it  is  upon 
such  evidence  that  a  great  part  of  our  practice  is  founded.  It  is  to 
this  latter  class  of  properties,  then,  that  it  is  the  author's  wish  to 
direct  the  attention  of  the  profession  ;  and  in  doing  so  he  may  be 
allowed  to  express  his  conviction,  that  if  the  directions  and  illus- 
trations to  be  given,  be  sufficiently  explicit  to  enable  the  profession 
to  employ  the  remedies  he  recommends,  the  results  will  be  satis- 
factory. 


USES  OF  SABADILLA  SEEDS.  9 

CHAPTER  I. 

Medicinal  Properties  of  Sabadilla  Seeds. 

CONSIDERABLE  difference  of  opinion  exists,  as  to  the  precise 
plant  which  yields  the  Sabadilla  seeds.  Some  authors  are  of  opin- 
ion that  they  are  the  produce  of  different  species  of  Veratrum  ; 
the  V.  Sabadilla,  V.  Ovbilia,  and  V.  Officinale — others,  of  the 
Vellozia  Squamata  ;  and  lately  the  plant  has  been  considered  as  a 
species  of  Xerophyllum,  the  X.  Sabadilla.  It  is  a  native  of  Mex- 
ico ;  it  has  been  placed  amongst  the  Colchicaceae,  but  in  some  of 
its  properties  it  appears  more  nearly  allied  to  the  Ranunculacese  ; 
very  little  that  is  certain,  however,  is  known  regarding  its  history. 
The  seeds  are  dark-coloured,  rugous  and  slightly  curved,  and  are 
contained  in  a  light  brown  capsule  about  half  an  inch  in  length. 
They  are  without  smell,  but  have  an  acrid  burning  taste.  When 
given  to  animals  in  sufficient  quantities  to  produce  poisoning,  their 
effects  are  marked  by  great  irritation  in  all  the  mucous  membranes, 
particularly  in  the  intestinal  canal,  in  the  mucous  membrane  of 
which  they  excite  inflammation  by  whatever  manner  the  poisonous 
matter  may  have  been  introduced  ;  and  along  with  this  effect,  great 
disturbance  of  the  nervous  system  comes  on  before  death. 

They  have  been  used  medicinally  in  the  form  of  powder,  ointment, 
and  infusion  for  destroying  pediculi,  and  internally  for  removing 
taenia,  and  for  the  cure  of  hydrophobia. * 

I  have  employed  two  preparations  ;  the  tincture  and  extract, 
made  from  Sabadilla  seeds,  with  considerable  advantage  in  some  cases. 
The  tincture  made  use  of  is  a  saturated  one,  prepared  by  digesting 
for  ten  days  a  quantity  of  the  seeds,  freed  from  their  capsules  and 
bruised,  in  as  much  strong  alcohol  as  will  cover  them.  It  forms  a 
useful  rubefacient  in  chronic  rheumatism  and  paralytic  cases,  and 
has  a  tendency  to  bring  out  a  slight  eruption  on  the  skin  after  it 
has  been  rubbed  for  some  days.  It  produces,  in  a  very  marked 
degree,  a  tingling  sensation,  similar  to  that  caused  by  Veratria;  and 
friction  with  it  ought  always  to  be  continued  until  this  effect  is 
brought  about  at  each  application. 

When  rubbed  over  the  heart,  this  tincture  has  in  some  instances 
the  effect  of  reducing  the  frequency  and  force  of  the  pulse,  in  a 
marked  degree,  and  has  often  appeared  useful  in  cases  of  nervous 
palpitation. 

The  extract  is  prepared  by  evaporating  the  saturated  tincture  made 
as  above  directed,  with  a  very  gentle  heat,  to  a  proper  consistence. 
When  given  internally  in  small  doses,  it  has  nearly  the  same  effects 

*  Hardy's  Travels  in  Mexico. 
JANUARY,  1838.— -#  2 


10  TURNBULL  ON  RANUNCULACEJE. 

as  Veratria,  and  may  be  employed  with  advantage  in  painful  rheu- 
matic and  neuralgic  affections.  One  sixth  part  of  a  grain,  made  into 
a  pill,  and  given  three  or  four  times  a  day,  appears  to  be  the  proper 
dose,  and  it  should  be  continued,  and  gradually  increased  in  quantity 
according  to  circumstances.  This  preparation  also  induces  sensations 
of  heat  and  tingling  on  the  surface  of  the  skin,  and  sometimes  acts 
as  a  diuretic. 

Preparation  of  Veratria. 

Veratria,  the  active  principle  of  the  Sabadilla  seeds,  was  discover- 
ed by  MM.  Pelletier  and  Caventou,  in  the  year  1819,*  and  about 
the  same  time  in  Germany  by  Meissner  and  Van  Mons.  In  their 
subsequent  investigations,  the  two  first-named  chemists  detected  the 
presence  of  a  similar  principle  in  the  bulb  of  the  Colchicum  Jlutum- 
nale,  and  in  the  root  of  the  Veratrum  Jllbum  :  the  substance 
obtained  from  the  colchicum,  however,  has  since  been  discovered  by 
MM.  Geiger  and  Hesse,  to  differ  from  Veratria  in  several  important 
particulars,  to  be  afterwards  noticed,  and  they  have  in  consequence 
considered  it  as  a  new  principle  under  the  name  of  Colchicine.^ 
The  true  nature  of  the  alcaloid  extracted  from  the  white  hellebore, 
is  still  unknown  ;  so  that  the  Veratria  of  commerce  may  be  consi- 
dered as  being  obtained  entirely  from  the  Sabadilla  seeds. 

Until  very  lately,  Veratria,  as  obtained  according  to  the  processes 
employed  by  its  discoverers,  was  considered  to  be  a  simple  body;  but 
from  the  recent  investigations  of  M.  Couerbe,  it  appears  to  consist  of 
four  distinct  substances,  to  which  he  has  given  the  names  Veratrine, 
Veratrin,  Sabadilline,  and  Mono-hydrate  of  Sabadilline;  and  these 
are  obtained  separately  in  the  following  manner  : — A  concentrated 
tincture,  made  by  digesting  Sabadilla  seeds  with  boiling  alcohol,  is 
slowly  evaporated  to  the  consistence  of  an  extract,  which  is  next 
dissolved  in  water  acidulated  with  sulphuric  acid,  and  the  solution 
filtered,  after  being  heated  to  the  boiling  temperature.  The  liquor 
obtained,  holds  dissolved  in  it  the  four  substances  above-mentioned, 
along  with  a  quantity  of  colouring  matter.  By  the  addition  of  potass, 
they  are  all  precipitated,  and  the  precipate  is  to  be  re-dissolved  in 
alcohol,  and  the  tincture  thus  obtained  is  evaporated  to  the  consis- 
tence of  an  extract,  and  this  again  dissolved  in  acidulated  water,  as 
before.  The  addition  of  potass  to  this  solution,  throws  down  a 
light-coloured  precipitate,  which,  when  dried,  is  nearly  white,  and 
constitutes  the  Veratria  of  commerce.  As  thus  obtained,  it  is  acrid, 
alcaline,  and  forms  incrystallizable  salts  with  acids. 

This  substance,  however,  is  still  in  an  impure  state,  and  is  again 
to  be  dissolved  in  water  acidulated  with  sulphuric  acid.  To  this 
solution  nitric  acid  is  to  be  added,  so  as  to  throw  down  an  abundant 
dark-coloured  precipitate.  The  liquid  is  next  poured  cautiously  off, 
•and  a  solution  of  potass  or  ammonia  is  added,  drop  by  drop,  as  long 

*  Journal  de  Physique,  1819.  f  Journal  de  Pharmacie,  1834. 


PREPARATION  OF  VERATRIA.  H 

as  any  precipitate  is  formed.  The  precipitate  is  next  to  be  washed 
with  cold  water,  and  dissolved  in  alcohol,  and  the  tincture  evaporated 
to  the  consistence  of  an  extract. 

By  treating  this  extract  with  boiling  water,  the  Sabadilline  and 
Mono-hydrate  of  Sabadilline  are  taken  up,  and  the  other  two  prin- 
ciples left  undissolved.  The  solution,  on  cooling,  deposits  the  Sa- 
badilline in  crystals,  and  the  Mono-hydrate  is  obtained  by  slowly 
evaporating  the  remaining  liquid  in  vacuo.  The  portion  of  the 
extract  left  undissolved  by  the  water,  is  next  treated  with  ether, 
which  takes  up  the  pure  Veratrine,  and  leaves  the  Veratrin. 

The  Veratria  of  commerce  is  then  a  very  complicated  substance ; 
but  as  it  is  the  only  form  which  has  yet  been  introduced  into  medi- 
cine, the  remarks  which  are  to  follow  are  applicable,  at  least  so  far 
as  we  yet  know,  to  it  alone.  It  is  prepared  in  the  form  of  a  fine 
subtile  powder,  varying  in  colour  from  light  brown  to  nearly  white  ; 
it  is  very  sparingly  soluble  in  water,  but  sufficiently  so  to  communi- 
cate a  sensibly  acrid  taste  to  the  fluid.  It  is  very  soluble  in  alcohol 
and  ether.  It  is  insoluble  in  alcalis,  but  combines  readily  with  acids, 
and  forms  incrystallizable  salts.  It  restores  the  blue  colour  of  litmus 
paper,  reddened  by  acid.  When  heated,  it  melts,  and  has  the  ap- 
pearance of  wax  ;  and  on  cooling,  presents  a  mass  of  a  brownish 
transparent  appearance. 

It  is  destitute  of  smell,  but  when  brought  in  contact  with  the  mu- 
cous membrane  of  the  nose,  it  occasions  violent  sneezing ;  when 
applied  to  the  conjunctiva,  it  excites  considerable  irritation,  and 
causes  an  abundant  flow  of  tears.  Its  taste  is  extremely  acrid,  but 
destitute  of  bitterness. 

According  to  the  experiments  of  MM.  Magendie  and  Andral, 
Veratria  acts  on  animals  as  a  powerful  irritant,  occasioning  rapid  in- 
flammation in  the  lining  membranes  of  the  cavities  intowhichit  is  in- 
troduced ;  ending  in  tetanus  and  death.*  There  is  some  discrepancy, 
however,  betwixt  its  effects  upon  the  intestinal  canal,  as  observed 
by  M.  Magendie,  and  those  that  have  come  under  the  author's  ob- 
servation, and  which  shall  now  be  noticed. 


Internal  Administration  of  Veratria  and  its  Salts. 

The  acknowledged  value  of  colchicum  autumnale  in  the  treat- 
ment of  a  variety  of  diseases,  appears  to  have  given  rise  to  consi- 
derable expectations  that  the  discovery  of  the  active  principle  of  the 
plant  would  be  of  great  advantage  to  medicine  ;  and  accordingly 
we  find,  that  no  sooner  had  MM.  Pelletier  and  Caventou  succeed- 
ed in  obtaining  Veratria,  than  a  number  of  experiments  were  in- 
stituted, with  a  view  to  determine  its  action  upon  the  animal  econo- 
my. These  were  principally  conducted  by  MM.  Andral  and  Ma- 
gendie, and  agreed  in  proving  it  to  be  possessed  of  most  energetic 
properties,  and  similar,  though  in  a  more  exalted  degree,  to  those 

*  Magendie,  JournaVde  Physiologic,  torn.  1. — Formulaire. 


12  TURNBULL  ON  RANUNCULACEJ3. 

ascribed  to  white  hellebore,  sabadilla  seeds,  and  colchicum,  by  Scha- 
bel,  Orfila,  Sir  Everard  Home,  and  other  observers.  Unfortunately, 
however,  these  properties  appeared  to  be  of  such  a  nature  as  almost 
to  preclude  the  possibility  of  Veratria  ever  being  employed  in  me- 
dicine. From  M.  Andral's  experiments  on  animals,  it  was  proved 
that  when  applied  directly  to  any  of  the  tissues,  it  produced  rapid 
inflammation  of  the  part  ;  and  that  when  introduced  in  small  doses 
into  the  system,  either  through  the  medium  of  the  veins  or  intes- 
tines, it  occasioned  violent  vomiting  and  purging  ;  and  in  larger 
doses,  tetanus  and  death. 

M.  Magendie  administered  it  internally  in  the  human  subject,  and 
found  that,in  the  dose  of  a  quarter  of  a  grain,  it  acted  powerfully  upon 
the  intestines,  and  produced  very  copious  dejections  ;  and  he  recom- 
mends its  employment  on  this  account,  as  a  convenient  remedy  in 
cases  requiring  a  speedy  action  upon  the  bowels,  particularly  in  old 
men,  in  whom  he  states  his  having  used  it  with  much  advantage  ; 
he  also  advises  its  substitution  for  the  preparations  of  colchicum,  in 
the  treatment  of  those  diseases  in  which  they  had  been  employed. 
Such,  however,  was  the  dread  inspired  by  the  observed  properties 
of  the  new  alcaloid,  that  few  practitioners  ventured  upon  a  trial  of 
it  ;  and  much  surprise  was  expressed  that,  with  these  before  his 
eyes,  M.  Magendie  should  have  ventured  upon  such  a  dangerous 
recommendation. 

Veratria  has  hitherto  been  little  employed  internally  in  this 
country  ;  but  where  it  has  been  used,  the  effects  produced  have 
been  nearly  similar  to  those  already  recorded  by  practitioners  on 
the  Continent  ;  and  agree  with  them  in  proving  it  to  be  possessed 
of  great  activity  as  a  purgative  and  emetic  :  so  much  so,  indeed,  that 
its  administration  appears  to  have  been  very  generally  abandoned, 
as  being  fraught  with  greater  danger,  from  this  circumstance,  than 
could  have  been  counterbalanced  by  any  good  effect  that  might  have 
arisen  from  it.  This  was  also  the  author's  opinion  at  the  time  his 
work  on  Veratria  was  published  ;  and  as  the  impressions  he  had 
received  from  the  writings  of  others  had  to  a  certain  extent  been 
confirmed  by  his  own  experience,  he  considered  it  his  duty  to  lay 
them  before  the  public.  Since  then,  however,  he  has  employed 
pure  Veratria  internally  to  a  considerable  extent,  in  consequence  of 
having  observed  that  its  salts  produced  none  of  those  effects  which 
had  been  ascribed  to  it,  and  in  very  few  cases  out  of  a  great  many  in 
which  it  has  been  employed,  even  when  given  to  the  extent  of  four 
or  six  grains  in  twenty-four  hours,  has  it  produced  the  slightest 
purgative  effect  :  it  has  often  occasioned  a  degree  of  nausea,  but  this 
may  easily  be  obviated  by  taking  care  that  too  large  a  dose  be  not 
given  at  one  time. 

To  what  are  we  to  ascribe  this  great  discrepancy  in  the  operation 
of  so  powerful  a  substance  ?  It  may  arise  from  one  of  two  causes, 
or  perhaps  from  both.  Veratria,  when  first  used,  appears  to  have 
been  obtained  in  part  from  the  colchicum  autumnale,  and  on  this 
account  differed  in  some  material  points  from  the  alcaloid,  as  it  is 


INTERNAL  ADMINISTRATION  OF  VERATRIA,  ETC.  13 

now  prepared  from  the  seeds  of  the  Veratrum  Sabadilla  :  so  much 
so,  that  it  has  been  described  as  a  new  principle  by  MM.  Geiger 
and  Hesse,  under  the  name  of  Colchicine  —  one  of  the  most 
prominent  properties  of  which,  according  to  those  gentlemen,  is  to 
produce  violent  purging  and  then  vomiting. 

Two  counter-experiments  are  related  by  them  :  in  one  of  which 
a  small  dose  of  Colchicine  was  given  to  a  cat :  at  the  end  of  an 
hour  it  was  violently  purged  ;  vomiting  next  came  on,  and  then 
death  ;  and  upon  examination,  it  was  found  that  violent  inflamma- 
tion had  taken  place  in  the  stomach  and  intestinal  canal,  with  san- 
guineous infiltration  throughout  their  whole  extent.  The  second 
experiment  was  made  upon  a  younger  cat,  and  a  smaller  dose  of 
Veratria  was  administered  :  the  animal  died  very  speedily,  but 
neither  vomiting  nor  purging  are  mentioned  as  having  been  pro- 
duced :  and  upon  examination,  it  was  observed  that  the  superior 
part  of  the  oesophagus  was  the  only  portion  of  the  alimentary  tract 
where  inflammation  had  taken  place  ;  and  it  was  remarked  that  this 
part  had  escaped  injury  in  the  animal  which  had  been  poisoned  by 
the  Colchicine*  These  facts  might  of  themselves  be  sufficient  to 
account  for  the  great  difference  in  the  observed  action  of  Veratria 
above  alluded  to  ;  but  it  ought  also  to  be  kept  in  mind,  that  it  is 
very  probable  the  alcaloid,  from  the  large  quantity  which  has  been 
lately  brought  into  the  market,  may  now  be  made  in  a  state  of 
greater  purity,  from  that  dexterity  in  its  manufacture  which  prac- 
tice alone  can  give.  Whichever  explanation  of  the  circumstance 
may  be  adopted,  it  certainly  appears  that  pure  Veratria,  or  any  of 
its  salts,  may  be  substituted  for  preparations  of  colchicum,  not  only 
with  perfect  safety,  but  with  considerable  advantage,  provided  an 
ordinary  degree  of  caution  be  observed  in  its  exhibition. 

The  best  form  of  administering  it  is  that  of  pill  ;  and  the  follow- 
ing prescription  is  the  one  I  generally  make  use  of: — 

R— Veratrise          .         .         .         .         .         .         .         .         gr.  ii. 

Pulv.  Rad.  Glycyrrh gr.  xii. 

Ext.  Hyoscyam gr.  vi. 

M.  fiat  mass,  in  pilul.  aequal.  duodecim.  divid.  quarum  sumat  unam  ter  in  die. 

For  the  two  last  ingredients  it  will  sometimes  be  found  advan- 
tageous to  substitute  a  few  grains  of  compound  rhubarb  pill,  espe- 
cially when  there  is  a  tendency  to  costiveness.  This  prescription  I 
have  found  very  useful  in  the  treatment  of  painful  spasmodic  affec- 
tions, rheumatism,  gout,  &c.  It  has  also  been  used  in  diarrhoea  with 
considerable  effect ;  and  in  this  disease  one  pill  ought  to  be  given 
after  each  stool,  until  the  relaxed  state  be  removed.  After  a  few 
doses  have  been  taken,  the  patient  generally  experiences  a  sensation 
of  warmth  in  the  stomach,  which  extends  over  the  abdomen,  chest, 
and  upper  and  lower  extremities  :  this  is  succeeded  by  a  feeling  of 
tingling  in  various  parts  of  the  body,  and  frequently  a  degree  of 
perspiration  is  induced. 

Veratria  has   been  combined  with  several  acids  ;  but  the  only 

*  Jour,  de  Pharmacie,  Mars  1834. 
2* 


14  TURNBULL  ON  RANUNCULACEjE. 

products  as  yet  obtained  that  are  fit  for  administration,  are  the  sul- 
phate, tartrate,  and  acetate. 

According  to  Professor  Turner,  and  M.  Courbe,  they  are  crys- 
tallizable,  when  prepared  from  pure  Veratria  ;  but  the  difficulty  in 
obtaining  them  in  this  state  must,  for  some  time  at  least,  render  it 
necessary  to  make  use  of  the  more  common  and  more  easily  pre- 
pared form.  In  this  condition  they  have,  when  solid,  very  much 
the  appearance  of  resins  ;  they  are  triable,  and  can  be  reduced  to  a 
fine  powder,  which  is  of  a  brownish  aspect.  They  are  all  very 
acrid  when  applied  to  the  tongue,  and  leave  a  sensation  of  heat  and 
tingling  in  the  part  of  the  mucous  membrane  with  which  they  may 
have  been  brought  in  contact. 

When  given  in  the  doses  to  be  presently  mentioned,  like  Vera- 
tria itself,  they  in  general  give  rise  to  the  following  effects  :  a  sen- 
sation of  warmth  in  the  stomach,  which  gradually  extends  itself  over 
the  abdomen  and  lower  part  of  the  chest :  after  the  dose  has  been 
repeated  once  or  twice,  the  same  feeling  is  experienced  in  the  lower 
extremities,  and  particularly  in  the  feet ;  the  upper  extremities  and 
head  become  also  affected  in  the  same  manner  :  and  if  the  medicines 
be  pushed  further,  a  sensation  of  tingling,  exactly  similar  to  that 
caused  by  frictions  with  Veratria  ointment  manifests  itself  in  vari- 
ous parts  of  the  body,  and  sometimes  over  the  whole  surface  of 
the  skin  ;  this  is  generally  accompanied  by  considerable  perspira- 
tion, and  some  feeling  of  oppression,  and  all  these  effects  are  aug- 
mented by  heat,  or  by  the  use  of  warm  diluents.  To  this  succeeds 
a  sensation  of  coldness  ;  and  should  their  administration  be  still 
continued,  the  stomach  becomes  affected,  and  a  degree  of  nausea 
takes  place,  followed  by  vomiting.  In  a  few  instances  only  have 
they  acted  as  diuretics,  and  in  still  fewer  as  purgatives.  No  narcotic 
effect  has  been  observed  to  arise  from  their  use. 

In  their  action  upon  disease,  the  salts  of  Veratria,  when  given 
internally,  are  possessed  of  powers  very  similar  to  those  exercised 
by  the  base  when  rubbed  upon  the  skin.  The  particular  diseases  in 
which  they  appear  to  be  of  most  service,  are  tic  douloureux,  gout, 
and  rheumatism,  especially  in  the  two  first  named.  In  the  treat- 
ment of  these,  any  of  the  salts  may  be  employed  ;  but  the  tartrate 
is  upon  the  whole  to  be  preferred,  as  it  is  less  liable  than  the  others 
to  give  rise  to  irritation  of  the  stomach  ;  either  of  them,  however, 
may  be  had  recourse  to  with  safety.  The  best  method  for  exhibiting 
them  is  the  form  of  pill,  made  according  to  the  following  prescrip- 
tion : 

R— Tart  Veratriae gr.  ii. 

Pulv.  Rad.  Glycyrrhiz gr.  xii. 

Mueilag.  Acaciae         .         .        .        .        .        q.  s.     Misce 
optime  et  divide  in  pilulas  aequales  duodecim,  quarum  sumat  imam  tertia  quaque 
hora. 

The  dose  of  the  tartrate  ordered  above  is  sufficient  to  begin  with, 
and  it  may  be  augmented,  until  the  quantity  given  amounts  to  a 
grain  and  a  half,  or  two  grains  in  the  course  of  the  day  :  beyond 


EXTERNAL  APPLICATION  OF  VERATRIA.  15 

which  it  will  not  be  necessary  to  push  the  medicine,  as  its  peculiar 
effects  in  general  show  themselves  before  that  quantity  is  used. 
Should  the  sulphate  or  acetate  be  preferred,  the  doses  administered 
ought  to  be  rather  less,  as  these  act  more  readily  upon  the  stomach 
than  the  tartrate.  M.  Magendie  has  suggested  the  form  of  solution 
for  the  employment  of  the  sulphate,  but  it  is  a  very  objectionable 
one,  both  on  account  of  its  taste,  and  from  the  disagreeable  sensations 
left  by  it  in  the  mouth  and  pharynx,  which  often  are  of  such  a  na- 
ture as  to  occasion  nausea  and  vomiting. 

In  any  case  in  which  it  may  be  desired  to  make  use  of  the  salts  of 
Veratria,  the  plan  that  appears  the  best  to  be  followed,  is  to  adminis- 
ter a  pill  every  three  hours,  until  the  sensation  of  heat  and  tingling 
manifests  itself,  and  when  this  takes  place,  some  alleviation  of  the 
pain  will  in  general  be  observed  ;  but  should  this  not  be  the  case, 
the  treatment  ought  to  be  persevered  in,  until  it  has  had  a  fair  trial, 
the  dose  being  at  the  same  time  augmented  accordingly  as  the  pa- 
tient can  bear  it.  In  some  instances,  it  has  not  been  found  necessary 
to  continue  the  pills  above  a  few  days,  whilst  in  others,  a  week  or 
two  has  been  required  to  produce  their  full  effects  ;  and  in  almost 
every  case,  it  has  been  requisite  to  regulate  the  bowels,  by  means  of 
gentle  aperients,  to  obviate  the  constipation  which  often  comes  on 
during  their  use.  When  the  disease  occurs  in  regular  paroxysms, 
the  pills  ought  to  be  resumed  an  hour  or  two  before  the  expected 
time  of  attack. 

External  Application  of  Veratria. 

Veratria  may  be  applied  externally,  either  in  solution,  in  alcohol, 
or  made  into  an  ointment  with  hog's  lard  :  the  latter  form  is  the  one 
which  has  been  most  generally  employed  ;  but  where  unctuous 
applications  are  objected  to,  an  embrocation  made  by  dissolving  from 
ten  to  twenty  or  more  grains  of  Veratria,,  in  an  ounce  of  boiling 
alcohol,  if  applied  in  the  same  manner  as  the  ointment,  will  prove 
equally  efficacious.*  The  ointment  may  be  made  with  similar 
proportions  of  the  alcaloid  to  an  ounce  of  lard,  and  of  this,  a  piece, 
the  size  of  a  large  nut,  may  be  rubbed  with  the  hand  from  five  to 
fifteen  minutes,  night  and  morning,  as  nearly  as  possible,  over  the 
seat  of  the  disease,  until  relief  from  the  urgent  symptoms  be  expe- 
rienced ;  care  being  taken  to  observe  that  the  skin  over  which  the 
friction  is  to  be  made,  be  free  from  injury,  otherwise  considerable 
irritation  of  the  part  will  ensue  :  and  for  reasons  already  given,  the 
person  who  applies  either  form, must  be  careful  not  to  insert  even  the 
smallest  quantity  under  the  eyelids. 

M.  Magendie  appears  to  have  been  the  first  person  who  suggest- 
ed the  external  application  of  Veratria  in  rheumatism,  gout,  and 
anasarca  ;  but  his  proposition  does  not  seem  to  have  been  complied 

*  In  cases  where  the  skin  is  irritable,  the  proportions  of  Veratria  employed, 
must  be  smaller  than  those  now  given. 


16  TURNBULL  ON  RANUNCULACE^E. 

with,  neither  does  he  himself  appear  to  have  been  fully  aware  of  its 
importance  in  a  medicinal  point  of  view  ;  and  indeed,  the  weakness 
of  the  preparations  recommended  by  him,  even  had  they  been  made 
use  of,  must  have  prevented  the  striking  effects  produced  upon  cer- 
tain diseases  by  the  Veratria,  when  more  freely  employed,  from 
coming  under  his  observation. 

The  skin  over  which  the  ointment  has  been  rubbed,  in  general 
shows  no  mark  of  irritation,  even  after  the  friction  has  been  conti- 
nued for  some  length  of  time :  sometimes  an  evanescent  blush  per- 
vades the  surface,  and  in  rare  instances  a  quantity  of  eruption  has 
appeared  upon  the  part,  but  these  bear  only  a  small  proportion  to 
the  cases  in  which  no  such  effects  are  produced.  When  a  small 
quantity  of  the  ointment  is  rubbed  in,  the  patient  generally  experien- 
ces a  considerable  degree  of  warmth  and  tingling  in  the  part,  and 
until  this  takes  place,  the  peculiar  effects  of  the  medicine  never  mani- 
fest themselves ;  the  circumstance,  therefore,  is  one  worthy  of  atten- 
tion, and  may  serve  as  a  criterion  whereby  to  estimate  the  extent  to 
which  the  friction  may  be  carried  without  producing  inconvenience, 
and  also  to  judge  of  the  degree  of  purity  of  the  Veratria  employed  ; 
for  when,  as  is  sometimes  found  to  be  the  case,  the  medicine  is  mixed 
with  impurities,  these  sensations  are  not  produced,  and  its  action  is 
by  no  means  either  so  certain  or  powerful  as  when  it  is  free  from 
adulteration.  This  last  observation  appears  necessary  to  prevent  the 
practitioner  from  laying  a  charge  of  failure  against  it  in  cases  where 
the  impure  Veratria  may  have  been  made  use  of  in  compounding 
the  prescription.* 

After  the  ointment  has  been  applied  a  sufficient  length  of  time  to 
put  the  constitution  completely  under  its  influence,  the  feeling  of 
heat  and  tingling  extends  itself  from  the  place  where  the  friction 
may  have  been  made,  over  the  whole  surface  of  the  body,  and  pro- 
duces sensations  similar  to  those  which  have  been  already  described 
as  arising  from  the  internal  use  of  Veratria  and  its  salts. 

The  sensibility  of  the  parts  over  which  the  application  has  been 
made,  is  increased  so  as  to  render  them  peculiarly  susceptible  of  the 
presence  of  certain  stimuli,  particularly  electricity  or  galvanism  ; 
these  agents  have  in  some  instances  been  applied  along  with  the 
Veratria  ointment,  but  have  given  rise  to  sensations  so  acute  as  to 
render  their  further  employment  almost  insupportable,  and  that 
without  the  slightest  perceptible  alteration  of  the  surface. 

Such  are  a  few  of  the  more  remarkable  effects  resulting  from  the 
application  of  the  Veratria  to  an  entire  surface,  and  in  the  great  ma- 
jority of  cases  these  will  be  found  sufficient  for  every  purpose  which 

*  Pure  Veratria  is  entirely  soluble  in  alcohol,  and  burns  without  leaving  any 
residuum ;  but,  perhaps  the  simplest  and  best  test  is  to  dissolve  four  grains  in  a 
drachm  of  alcohol,  and  to  rub  a  small  quantity  of  this  solution  on  the  wrist  or 
forehead  ;  when  the  Veratria  is  good,  the  heat  and  tingling  manifest  themselves 
after  the  friction  has  been  continued  for  two  or  three  minutes,  and  the  length  of 
time  required  to  produce  this  effect  affords  a  tolerably  correct  estimate  of  the  effi- 
cacy of  the  medicine. 


EXTERNAL  APPLICATION  OF  VER ATRIA,  ETC.  17 

they  are  intended  to  serve  :  in  some  affections,  however,  in  which 
the  symptoms  are  more  severe,  or  which  are  seated  in  parts  only 
thinly  covered  by  integuments,  the  attempt  has  been  made  to  apply 
it  directly  to  a  part  denuded  of  the  cuticle,  but  although  the  effects 
upon  the  disease  were  much  greater  than  when  the  surface  remained 
unbroken,  yet  the  extreme  irritation  which  followed  the  practice 
rendered  its  repetition  impossible. 


External  Application  of  Veratria  in  Affections  of  the  Heart. 


When  any  of  the  preparations  of  Sabadilla  or  Veratria  are  adminis- 
tered in  repeated  small  doses  by  the  mouth  ;  besides  exerting  their 
peculiar  effects  upon  the  nerves  of  sensation  already  mentioned,  they 
act  also  upon  the  circulating  system.  In  many  instances  the  force 
and  frequency  of  the  pulse  are  remarkably  diminished  by  them,  and 
the  circulation  is  rendered  more  regular ;  whilst  in  others,  a  contrary 
effect  is  produced.  This  appears  to  be  the  result  of  the  influence 
exerted  by  the  medicine  on  the  nervous  system,  for  it  takes  place 
chiefly  in  those  whose  nerves  are  easily  excitable  ;  in  some  cases, 
also,  in  which  organic  disease  of  the  heart  has  been  present,  the 
internal  exhibition  of  one  or  other  of  the  preparations  has  afforded 
the  patient  considerable  relief,  but  apparently,  not  so  much  byacting 
upon  the  nervous  system,  as  upon  the  kidneys,  and  thus  removing 
some  effusion  existing  in  the  chest,  and  which  was  the  immediate 
cause  of  the  aggravated  symptoms. 

Precisely  the  same  effects  are  produced,  when  Veratria  ointment, 
or  the  tincture  of  Sabadilla,  are  rubbed  over  the  region  of  the  heart, 
though  perhaps  not  in  so  great  a  degree.  This  latter  method, 
however,  of  employing  Veratria,  is  upon  the  whole  the  preferable 
one,  as  in  many  cases  the  stomach  might  be  incommoded  by  the 
internal  use  of  it,  and  in  addition  to  its  action  on  the  heart,  there  is 
also  another  exerted,  when  it  is  applied  to  the  skin,  namely,  the 
tingling,  which  of  itself  appears  to  have  a  beneficial  effect,  especially 
in  nervous  cases,  probably  by  acting  as  a  counterstimulant,  whilst 
the  quantity  absorbed  during  the  friction  is  sufficient  to  produce  its 
other  effects  on  the  system. 

From  the  observations  which  I  have  made  on  the  action  of 
Veratria  in  affections  of  the  heart,  I  have  been  led  to  conclude,  that 
there  are  some  cases  in  which  the  symptoms  may  be  removed  by 
its  use,  though  of  a  class  that  might  have  been  considered  as  indica- 
ting confirmed  organic  disease ;  amongst  the  following,  will  be 
found  instances  of  this  kind,  and  others  could  have  been  given ; 
these  have  occurred  in  patients  in  whom  a  gouty  or  rheumatic 
diathesis  has  been  present,  and  this  fact  may  perhaps  afford  some 
explanation  of  the  effects  of  the  remedy. 

There  are,  then,  three  states  of  disease,  in  which  the  ointment 
may  be  tried:  namely,  simple  nervous  palpitation;  in  the  same 
affection  occurring  in  gouty  subjects;  and  as  a  diuretic  in  cases  of 
organic  disease,  though  of  course  in  instances  of  this  kind  any 


18  TURNBULL  ON  RANUNCULACE^E. 

relief  which  it  may  give,  can  at  best  be  only  temporary ;  it  has, 
nevertheless,  given  relief,  and  if  it  should  do  no  good  it  will  at  least 
do  no  mischief. 

The  application  best  adapted  for  this  class  of  affections,  consists 
of  fifteen  or  twenty  grains  of  Veratria,  made  into  an  ointment  with 
an  ounce  of  lard,  and  of  this  a  piece  the  size  of  a  nut,  should  be 
rubbed  over  the  region  of  the  heart  for  five  minutes  every  night, 
and  it  may  be  continued  according  to  the  effect  produced. 


CASE  I. 

A  LADY,  fifty-five  years  of  age,  was  attacked  seven  years  ago 
with  what  her  medical  attendants  considered  to  be  an  inflammatory 
affection  of  the  lungs,  and  for  which  she  was  profusely  bled,  and 
otherwise  actively  treated.  The  violent  symptoms  were  by  these 
means  removed  ;  but  there  still  remained  a  degree  of  weakness  and 
affection  of  the  chest,  sufficient  to  confine  her  almost  constantly  to 
her  room  for  nine  months  afterwards.  Since  that  time,  she  has 
recovered  considerably,  but  has  been  under  the  necessity  of  remain- 
ing in  an  apartment,  kept  at  an  equable  temperature,  during  the 
winter;  and  with  the  prospect  of  being  obliged  to  continue  the  same 
regimen  for  the  remainder  of  her  life. 

Throughout  the  whole  seven  years  she  has  had  constant  cough, 
attended  with  scanty  mucous  expectoration :  a  difficulty  of  breath- 
ing so  great,  as  to  prevent  her  sleeping  at  night,  or  even  remaining 
in  the  recumbent  posture  for  any  length  of  time  without  bringing 
on  distressing  fits  of  coughing:  respiration  very  much  hurried,  and 
the  lips  of  a  purplish  hue:  pulse  so  small,  rapid,  and  irregular,  as  to 
render  it  difficult  to  ascertain  the  number  of  its  beats.  Over  the 
region  of  the  heart,  and  over  a  great  part  of  the  anterior  surface  of 
the  thorax,  there  was  a  very  perceptible  undulatory  motion,  al- 
together different  from  ordinary  pulsation ;  and  the  ear,  applied  to 
the  chest  over  the  same  region,  distinguished  the  heart's  action  to 
be  extended,  indistinct,  and  undefined  in  character.  Along  the 
whole  length  of  the  left  arm,  from  the  shoulder  to  the  points  of  the 
fingers,  she  complained  of  pain  and  a  feeling  of  numbness,  which 
rendered  the  extremity  almost  useless:  this  symptom  had  lasted 
about  four  years.  There  was  no  very  marked  derangement  in  the 
digestive  organs.  The  bowels  were  regular,  the  appetite  pretty 
good ;  but  there  existed  a  slight  degree  of  flatulence,  not  however 
so  great  as  to  occasion  much  inconvenience,  and  there  was  nothing 
Very  particular  in  the  appearance  of  the  tongue. 

The  patient  had  previously  been  under  almost  every  variety  of 
treatment,  but  without  receiving  any  benefit.  Upon  the  supposi- 
tion that  there  might  be  some  accumulation  in  the  bowels  sufficient 
to  aggravate  the  symptoms,  she  was  directed  to  use  aperient  medi- 
cine for  a  few  days,  but  without  producing  any  alleviation.  She 
was  then  put  under  the  influence  of  small  and  repeated  doses  of  the 


EXTERNAL  APPLICATION  OF  VER ATRIA,  ETC.  19 

tartrate  of  antimony,  and  along  with  this  treatment,  frictions  with 
croton  oil  were  applied  over  the  chest  and  down  the  left  arm,  until 
a  pretty  free  eruption  was  brought  out.  Under  this  plan  the  patient, 
for  the  first  time  from  the  commencement  of  her  illness,  experienced 
decided  relief;  and  it  should  certainly  have  been  persevered  in 
until  a  fair  trial  had  been  given  to  it,  had  not  such  a  degree  of 
debility  supervened,  as  to  give  rise  to  considerable  doubt  whether 
or  not  it  could  be  continued  with  safety ;  the  cough  and  difficulty 
of  breathing  had  very  much  diminished  in  severity,  but  the  pain  in 
the  arm  remained  unabated,  and  at  the  end  of  ten  days  she  would 
not  consent  to  the  further  employment  of  the  remedies,  and  they 
were  in  consequence  given  up. 

Before  the  time  at  which  this  patient  came  under  treatment,  the 
very  striking  effects  which  the  Veratria,  when  applied  externally, 
exercises  upon  the  pulse,  in  removing  irregularities  and  intermissions, 
and  in  diminishing  its  frequency,  had  presented  themselves  to 
observation ;  and  although  it  was  not  anticipated  that  very  great 
benefit  could  arise  from  its  use  in  a  case  so  apparently  hopeless,  it 
nevertheless  appeared  probable  that,  at  least,  a  temporary  relief 
from  the  violence  of  the  symptoms  might  be  procured,  if  the  medi- 
cine only  acted  upon  the  circulation,  without  inducing  such  a  degree 
of  general  debility  as  had  resulted  from  the  means  previously  had 
recourse  to.  A  piece,  as  large  as  a  nut,  of  an  ointment  composed 
of  fifteen  grains  of  Veratria  and  an  ounce  of  hog's  lard,  was  ac- 
cordingly directed  to  be  rubbed  twice  a-day  over  the  chest  and 
along  the  affected  arm  five  minutes  each  time,  and  the  result  very 
far  exceeded  the  expectations  formed.  The  first  application  re- 
lieved the  chest  symptoms  considerably.  The  cough  and  breath- 
lessness,  to  a  certain  extent,  subsided,  and  the  pulse  and  action  of 
the  heart  were  greatly  improved :  the  most  decidedly  beneficial 
effects  however  were  produced  upon  the  extremity ;  the  pain  and 
numbness  had  not  altogether  disappeared,  but  these  symptoms  were 
so  much  alleviated,  as  to  induce  the  patient  to  state  that,  comparatively 
speaking,  she  had  recovered  the  entire  use  of  her  arm.  From  this 
time  the  ointment  was  directed  to  be  used  every  evening  for  about 
ten  days,  and  then  only  occasionally,  as  it  might  be  found  ne- 
cessary. 

In  about  a  fortnight  from  the  first  application  of  the  Veratria,  the 
patient  was  able  to  leave  her  room  and  walk  up  and  down  stairs 
with  facility;  and  the  general  improvement  of  her  health  was  such, 
that  she  ventured  into  the  open  air,  but  in  consequence  of  incautious 
exposure,  the  symptoms  returned  two  or  three  times,  though  by  no 
means  with  the  same  severity  as  before ;  and  when  such  an  occur- 
rence took  place,  one  or  two  rubbings  with  the  ointment  afforded 
complete  relief.  She  is  now  in  comparative  health;  her  general 
appearance  is  good,  the  pain  and  numbness  of  the  arm  have  entirely 
disappeared,  the  circulation  is  much  more  regular  than  it  has  been 
for  a  great  length  of  time,  the  cough  and  difficulty  of  respiration  are 
almost  gone,  and  she  can  now  remain  in  the  recumbent  position, 


20  TURNBULL  ON  RANUNCULACE.E. 

and  enjoy  a  good  night's  rest ;  and  the  last  time  I  saw  her,  she  had 
walked  about  four  miles  without  any  inconvenience. 


CASE  II. 

MR.  B.,  aged  thirty-six,  of  sedentary  habits,  and  by  profession  a 
banker's  clerk,  was  seized  about  ten  years  ago,  without  any  apparent 
cause,  with  palpitation  on  the  left  side  of  the  thorax,  which  was 
followed  by  pain  and  a  sensation  of  tightness  and  anxiety  over  the 
region  of  the  heart;  his  pulse  became  irregular  and  intermittent; 
his  breathing,  however,  has  not  been  to  any  great  degree  disturbed, 
and  he  has  been  able  to  take  free  exercise,  and  with  some  benefit. 
During  the  course  of  his  illness  he  has  had  no  cough,  but  has  had 
occasional  sighing. 

The  digestive  functions  have  been  considerably  impaired,  the 
appetite  bad,  the  bowels  disordered,  and  an  almost  constant  tendency 
to  flatulence  has  been  present.  The  nervous  system  has  also  been 
for  some  time  under  much  derangement,  marked  by  tremors  in  the 
hands,  irritability  of  temper,  disturbance  of  the  mental  powers, 
particularly  of  the  memory,  which  has  suffered  a  good  deal  in  its 
integrity  ;  for  some  time  past  he  has  experienced  a  disinclination 
for  exertion,  and  has  gone  through  his  business  more  as  a  matter  of 
duty  than  of  pleasure.  His  sleep  has  been  disturbed  and  unrefresh- 
ing;  and  he  has  laboured  under  great  depression  of  spirits,  from  the 
belief  that  his  complaint,  from  the  number  of  remedies  he  had  tried 
without  advantage,  was  incurable. 

Under  these  circumstances,  and  considering  from  the  account  he 
had  given,  that  to  attempt  a  cure  by  the  means  usually  employed 
in  such  cases,  would  only  be  a  waste  of  time,  and  also  in  consequence 
of  the  success  which  had  attended  the  previous  trials  made  with  the 
Veratria,  it  was  determined  at  once  to  employ  it  in  his  case ;  and 
with  this  view  he  was  directed  to  take  a  little  opening  medicine,  a 
practice  always  necessary  to  be  pursued  during  the  time  the  Veratria 
is  in  use;  and  an  ointment  of  the  same  strength  as  that  applied  in 
the  preceding  case,  was  ordered  to  be  rubbed  on,  night  and  morning, 
over  the  region  of  the  heart.  As  the  patient  lived  at  some  distance 
he  did  not  present  himself  again  until  the  end  of  a  week,  when  he 
returned  to  announce  that  he  was  quite  well.  The  palpitation  and 
nervous  symptoms  had  entirely  vanished,  and  he  was  then  in  the 
enjoyment  of  the  best  health  and  spirits.  I  have  seen  him  once 
since  that  time,  and  he  has  not  had  the  slightest  return  of  his  com- 
plaint 

CASE  III. 

MRS.  L.,  a  lady  thirty-six  years  of  age,  and  of  a  spare  habit  of 
body,  residing  in  Bristol,  has  been  suffering  for  five  years  from 
palpitation  of  the  heart,  attended  by  considerable  difficulty  of  breath- 


EXTERNAL  APPLICATION  OF  VERATRIA,  ETC.  21 

ing.  She  dates  the  commencement  of  her  disease  from  a  severe 
inflammatory  affection  of  the  chest,  occasioned  by  cold  caught 
during  her  confinement.  To  relieve  the  chest  symptoms,  bleeding 
and  other  antiphlogistic  measures  were  had  recourse  to ;  but  the 
palpitation  continued  to  such  a  degree,  as  to  render  her  incapable 
of  taking  any  exercise  without  materially  aggravating  her  symptoms. 
She  has  had  many  exacerbations  arising  from  slight  causes,  and  yet 
so  severe  as  to  render  venesection  necessary  to  alleviate  the  violent 
throbbing  in  the  left  side  of  the  thorax.  Her  eyes  are  suffused,  her 
memory  impaired,  and  she  has  a  considerable  degree  of  nervous 
irritability.  Her  breathing  is  difficult,  accompanied  by  slight 
cough  and  a  sense  of  partial  suffocation,  along  with  pain  across  the 
region  of  the  heart  and  down  the  left  arm,  and  these  feelings  are 
materially  increased  by  walking  or  any  other  exertion.  Her  pulse 
is  irregular  and  quick ;  bowels  costive ;  feet  generally  cold  ;  and  her 
sleep  interrupted  by  the  palpitation. 

While  labouring  under  these  symptoms  she  was  put  under  the 
influence  of  small  doses  of  tartrate  of  antimony  and  blue  pill;  and 
at  the  same  time  an  embrocation  of  croton  oil  was  ordered  to  be 
rubbed  over  the  chest  and  down  the  affected  arm,  until  a  free  erup- 
tion was  produced.  So  long  as  the  patient  continued  this  plan  of 
treatment,  and  remained  quiet,  she  experienced  great  relief;  but  the 
palpitation  returned  nearly  as  violent  as  ever,  upon  slight  exertion, 
and  she  now  began  to  complain  of  a  degree  of  debility  which  she 
had  not  before  been  subject  to.  Under  these  circumstances,  she 
was  ordered  to  have  an  ointment  prepared  with  twenty  grains  of 
Veratria  to  an  ounce  of  lard,  rubbed  in  the  usual  quantity  over  the 
region  of  the  heart  for  five  minutes  night  and  morning;  and  owing 
to  the  severity  of  the  pain  in  the  arm,  frictions  with  the  croton  oil 
were  ordered  to  be  made  along  it,  until  a  raw  surface  was  obtained, 
and  over  this  (he  Veratria  ointment  was  applied. 

On  the  night  after  the  first  application  the  symptoms  were  very 
much  diminished  in  intensity,  but  the  Veratria  had  occasioned  a 
degree  of  heat  and  tingling  in  the  arm,  so  great  as  to  prevent  her 
sleeping;  the  pain,  however,  never  afterwards  returned.  In  three 
or  four  days  she  began  to  take  exercise  without  inconvenience ; 
from  this  time  she  gradually  improved,  and  at  the  end  of  three 
weeks  left  town,  and  returned  home  quite  well. 


CASE  IV. 

MR.  J.,  a  clergyman,  fifty  years  of  age,  has  been  affected  with 
severe  palpitation  for  the  last  seven  years,  accompanied  by  quickness 
and  irregularity  of  the  pulse,  difficulty  of  breathing,  loss  of  voice, 
cough,  expectoration,  and  a  distressing  sense  of  anxiety  ;  has  some- 
times been  seized  in  the  pulpit  with  giddiness,  succeeded  by  throb- 
bing in  the  neck  and  confusion  of  intellect,  and  these  symptoms 
have  occasionally  gone  on  to  such  an  extent  as  to  oblige  him  to  de- 

JANUARY,  1838.— C  3 


22  TURNBULL  ON  RANUNCULACE.E. 

sist  from  his  duties  for  two  or  three  months  at  a  time  :  his  bowels 
are  regular,  and  his  digestion  generally  good. 

He  was  ordered  to  take  small  doses  of  tartar  emetic,  and  to  have 
a  blister  applied  over  the  chest ;  and  this  treatment  was  pursued 
with  considerable  advantage  for  the  time,  but  when  it  was  remitted 
he  soon  returned  to  the  same  state  as  before.  As  this  seemed  a  fair 
case  upon  which  to  make  trial  of  the  Veratria,  it  was  ordered  to  be 
rubbed  on  in  the  manner  already  described.  By  making  use  of  the 
frictions  once  every  night  he  became  gradually  better,  and  at  the 
end  of  a  week  considered  himself  quite  well  ;  he  was  advised,  how- 
ever, to  continue  the  ointment  for  a  little  longer,  and  then  to  leave 
it  off  by  degrees  :  this  was  accordingly  done  about  a  year  and  a 
half  ago,  and  he  has  remained  ever  since  in  excellent  health,  free 
from  his  old  complaints,  and  able  for  the  discharge  of  the  functions 
of  his  office. 

CASE  V. 

MR.  W.,  aged  fifty-eight,  has  been  affected  for  seventeen  years 
with  palpitation,  which,  during  the  last  seven  of  that  period  has  been 
attended  by  great  difficulty  of  breathing,  occurring  in  paroxysms, 
and  coming  on  especially  whilst  taking  exercise  on  foot.  The  dysp- 
noea at  these  times  has  been  so  severe,  and  has  been  accompanied 
by  such  extreme  pain  across  the  chest,  as  to  compel  him  to  lay  hold 
on  the  nearest  object  for  support.  The  pain,  during  the  fit,  extends 
down  the  left  arm  ;  and  is  of  such  intensity,  that  in  the  words  of  the 
patient,  "  no  language  can  describe  it." 

For  these  and  other  symptoms  he  has,  during  the  last  ten  years, 
applied  to  all  sources  for  relief,  and  almost  every  possible  remedy 
has  been  tried  without  procuring  for  him  any  ease.  At  the  time 
he  came  under  treatment,  he  had,  besides  the  symptoms  mentioned, 
a  purple  blush  upon  his  face,  and  more  particularly  over  his  nose 
and  lips  ;  his  voice  was  weak  and  quivering.  Upon  applying  the 
ear  over  the  region  of  the  heart,  a  tremulous,  confused,  irregular  pul- 
sation was  heard  :  the  pulse  was  irregular  and  very  intermittent  : 
the  left  side  of  the  chest  appeared  much  larger  than  the  right,  and 
the  ribs  over  the  cardiac  region  seemed  pushed  out  as  if  to  afford  a 
larger  space  for  the  heart's  action.  There  was  considerable  disten- 
sion of  the  abdomen,  along  with  a  very  evident  degree  of  enlarge- 
ment on  the  right  side,  immediately  under  the  margins  of  the  ribs; 
his  bowels  had  been  for  some  time  in  a  very  torpid  state,  and  re- 
quired active  medicines  to  operate  upon  them  ;  the  lower  extremi- 
ties were  a  little  swollen,  and  the  urine  deficient  in  quantity.  His 
sleep  was  un  refresh  ing,  and  often  disturbed  by  fits  of  coughing,  which 
generally  ended  in  great  exhaustion. 

As  it  was  evident,  that  in  a  case  of  such  severity  and  duration, 
little  more  could  be  done  than  merely  to  relieve  the  sufferings  of 
the  patient,  by  endeavouring  to  mitigate  the  symptoms  as  much  as 
possible,  the  treatment  followed  was  addressed  to  that  end.  A  course 


EXTERNAL  APPLICATION  OF  VERATRIA,  ETC.  33 

of  medicine  was  prescribed,  consisting  of  purgatives  combined  with 
antacids,  for  the  purpose  of  clearing  out  the  bowels  and  removing 
the  distension  of  the  abdomen.  These  means  were  employed  alone, 
for  about  a  week,  and  then,  with  the  addition  of  a  little  squill  to  the 
pills  previously  ordered,  it  was  persevered  in  for  a  fortnight  longer  ; 
at  the  end  of  which  time  he  felt  considerably  better.  The  swelling 
in  the  legs  had  diminished,  the  digestion  was  improved,,  and,  altoge- 
gether,  he  was  in  a  more  favourable  state  of  health  than  before. 

During  the  previous  treatment  of  this  case,  counter-irritation,  by 
means  of  blisters,  issues,  tartar  emetic  ointment,  &c.,  had  been  freely 
employed,  and  with  so  little  effect,  further  than  bringing  about  a 
temporary  alleviation,  that  the  patient  would,  on  no  account,  consent 
to  their  repetition  now,  and  he  was  therefore  recommended  to  make 
use  of  the  Veratria  ointment,  but  certainly  without  any  great  expec- 
tations of  its  producing  a  beneficial  effect. 

An  ointment  of  the  usual  proportions  was  ordered  to  be  rubbed, 
for  five  minutes,  night  and  morning,  over  the  region  of  the  heart  ; 
and,  in  the  course  of  three  days,  the  feeling  of  pain  and  constriction 
across  the  chest  had  disappeared.  As  the  pain  in  the  left  arm  still 
remained,  he  was  ordered  to  use  frictions  with  the  ointment  to  it 
also,  and  almost  immediate  relief  from  that  symptom  followed  the 
application.  In  the  course  of  a  fortnight  from  the  time  the  Veratria 
was  had  recourse  to,  the  most  decidedly  beneficial  effects  had  been 
produced  upon  the  disease  :  the  pulse  and  action  of  the  heart  had 
become  much  more  regular  and  natural,  the  difficulty  of  breathing 
had  very  much  diminished,  the  complexion  was  completely  changed, 
and  exhibited  signs  of  an  unimpeded  circulation;  and  this  improve- 
ment went  on  gradually,  under  the  occasional  use  of  the  ointment, 
along  with  a  little  medicine  to  act  upon  the  bowels,  so  that,  in  about 
six  weeks  he  could  walk  about,  and  go  up  and  down  stairs  without 
inconvenience.  As  this  case  was  one  in  which  a  cure  could  not  be 
expected,  the  patient  was  left  to  himself  with  directions  to  rub  the 
ointment  whenever  a  return  of  pain  or  uneasiness  rendered  its 
employment  necessary.  This,  he  accordingly  does,  and  by  its  means, 
is  enabled  to  pursue  his  avocations  with  ease  and  comfort.  Before 
taking  leave  of  this  case  it  is  proper  to  state,  that  it  was  one  of  those 
in  which  the  Veratria  exerted  its  peculiar  diuretic  effects  ;  for, 
during  the  first  week  it  was  used,  no  less  than  six  pints  of  urine  a 
day  were  evacuated  by  the  patient. 


CASE  VI. 

MRS.  C.,  a  lady  betwixt  fifty  and  sixty  years  of  age,  has  been  ill 
about  nine  years.  During  the  first  three  she  suffered  from  dyspepsia 
and  irregularity  of  the  bowels,  and,  for  six  years,  she  has  been  affec- 
ted with  almost  constant  palpitation  and  difficulty  of  breathing  ; 
which  symptoms  she  describes  as  having  been  on  the  increase,  until 
at  last  sne  was  obliged  to  confine  herself  to  one  floor  of  the  house, 


24  TURNBULL  ON  RANUNCULACE^. 

from  inability  to  ascend  or  descend  the  stairs,  and  to  refrain  from 
walking,  under  the  impression  that  the  exertion  might  prove  fatal. 

She  has  violent  pulsation  over  the  region  of  the  heart,  along  with 
an  irregular  and  intermittent  pulse,  and  complains,  at  times,  of  severe 
pain  across  the  chest,  and  stretching  down  the  left  arm  :  her  lips  are 
of  a  purplish  colour  ;  her  eyes  dull  ;  her  countenance  sallow  ;  and 
she  labours  under  considerable  nervous  irritability,  accompanied  by 
impairment  of  the  memory  !  she  has  a  degree  of  fulness  in  the  right 
side,  under  the  margin  of  the  ribs,  and  her  feet  are  generally  cold, 
and  a  little  swollen.  For  these  symptoms  she  had  previously  been 
treated  by  bleeding,  blistering,  purgatives,  and  indeed,  every  thing 
possible  appeared  to  have  been  done,  without  procuring  any  abate- 
ment of  the  disease. 

From  the  disordered  state  in  which  the  digestive  organs  evident- 
ly were,  she  was  put  under  a  plan  of  treatment  similar  to  the  one 
pursued  in  the  preceding  case,  for  about  three  weeks,  but  no  diminu- 
tion of  the  symptoms  took  place;  and  then  the  Veratria  ointment 
of  the  usual  strength,  was  ordered  to  be  rubbed  over  the  left  side 
of  the  chest,  and  down  the  arm,  every  night.  The  first  application 
afforded  great  relief  to  the  palpitation  and  difficulty  of  breathing, 
and  the  pain  in  the  arm  was  also  considerably  alleviated.  In  the 
course  of  a  few  days  all  the  symptoms  were  nearly  gone ;  the  oint- 
ment was,  however,  directed  to  be  applied  occasionally,  for  about 
a  month  :  and  at  the  end  of  that  time,  the  patient  could  walk  with 
ease,  three  miles  at  a  time,  and  returned  home  quite  well,  and  has 
had  no  return  of  the  disease  since. 


CASE  VII. 

THE  following  case  is  given  for  the  purpose  of  showing  the  effect 
which  the  Veratria  has  upon  the  circulation,  in  a  disease  attended 
by  symptoms  of  great  development  of  the  heart's  action,  occasioned 
by  simple  hypertrophy  of  the  walls  of  -'the  left  ventricle.  Every 
one  must  have  remarked  the  difficulty  which  there  exists  of  modera- 
ting the  pulsation  of  the  heart  and  arteries,  in  this  disease,  and  that, 
in  consequence,  it  is  no  easy  matter  to  procure  even  a  temporary 
relief  from  the  distressing  sensations  experienced  by  those  who  are 
affected  by  it.  The  cases  of  this  kind,  in  which  the  ointment  has 
been  resorted  to,  are  not  sufficiently  numerous  to  warrant  the  as- 
sertion, that  decidedly  beneficial  effects  will  result  from  its  applica- 
tion in  every  instance;  but  it  will,  nevertheless,  be  allowed,  that 
the  subject  is  worthy  of  attention,  from  the  fact  of  its  having  al- 
ready proved  successful  in  doing  so. 

Mrs.  S.,  a  lady  about  sixty  years  of  age,  has,  during  the  last  five 
years,  suffered  much  from  violent  beating  of  the  heart,  attended  by 
strong  pulsation  in  the  neck,  throbbing  and  giddiness  in  the  head, 
and  a  continued  whizzing  noise  in  the  left  ear,  along  with  feelings 
of  anxiety,  and  considerable  nervous  irritability. 


INTERNAL  APPLICATION  OF  VERATRIA,  ETC.  25 

The  action  of  the  heart  is  strong,  constant,  and  concentrated  in  a 
space  over  the  situation  of  the  apex,  and  communicates  a  powerful 
impulse  to  any  thing  placed  on  it;  the  pulse  is  very  full,  throbbing, 
and!  incompressible  ;  the  carotid  arteries  beat  violently,  and  the 
patient  complains  much  of  the  noise  in  her  ear,  and  of  giddiness; 
she  has  also  confusion  of  ideas,  and  a  feeling  of  heat  and  fulness  in 
the  head.  She  has  considerable  anxiety,  and  her  sleep  is  interrupted 
by  palpitation.  There  is  some  pain  in  the  region  of  the  heart;  and 
all  these  symptoms  are  materially  augmented  by  exertion  ;  but  this, 
from  the  sensation  of  lassitude  which  she  almost  constantly  labours 
under,  cannot  be  made  to  any  great  extent 

The  bowels  are  generally  costive,  and  require  the  employment 
of  active  purgatives,  which  are  the  only  medicines  capable  of  re- 
moving the  uneasy  feelings  of  the  patient,  to  any  degree ;  the  digestive 
functions  are  very  active,  and  the  appetite  preternaturally  great. 
She  complains  neither  of  difficulty  of  breathing,  cough,  nor  pain  in 
the  arm.  In  the  previous  treatment  of  this  case  nothing  had  been 
found  useful,  and  as  it  did  not  appear  that  any  bad  consequence 
could  arise  from  the  external  application  of  the  Veratria,  it  was 
ordered  to  be  rubbed  over  the  region  of  the  heart,  in  the  usual 
manner,  after  purgatives  had  been  admin istered,  for  a  few  days,  to 
regulate  the  bowels. 

After  the  first  or  second  friction  with  the  ointment,  all  the 
symptoms  were  materially  diminished  in  intensity;  the  palpitation 
had  greatly  subsided  ;  the  pulse  had  become  much  softer  and  weaker ; 
the  anxiety,  the  pulsation  in  the  head,  the  feeling  of  giddiness,  the 
confusion  of  intellect,  and  the  sensation  of  whizzing  in  the  ear,  had 
all  disappeared,  and  the  general  health  and  appearance  of  the  patient 
were  much  improved  ;  but  still  some  of  the  symptoms  remained,  not, 
however,  to  such  a  degree  as  to  occasion  inconvenience,  and  she  is 
now  in  a  comfortable  state,  and  able  to  follow  her  household  em- 
ployments; though  exertion,  to  any  great  extent,  cannot  be  used 
without  aggravating  her  complaints.  From  the  manifest  benefit 
experienced  from  the  Veratria  ointment,  she  uses  it  herself  when- 
ever, from  any  cause,  an  increase  in  the  symptoms  takes  place,  and 
with  the  effect  of  procuring  immediate  relief. 


CASE  VIII. 

A  GENTLEMAN,  aged  about  sixty,  of  a  weak  constitution,  of  seden- 
tary habits,  and  given  to  mental  occupations,  has  laboured,  for  seven 
years,  under  slight  palpitation,  accompanied  by  feelings  of  anxiety 
and  general  languor,  coming  on  at  intervals,  and  increased  by  exer- 
tion ;  his  pulse  is  feeble,  rapid,  and  intermitting ;  palpitation  over 
the  lower  part  of  the  left  side,  not  excessive,  but  attended  with  a 
painful  sensation  in  the  region  of  the  heart,  which  is  so  augmented 
by  walking,  especially  against  the  wind,  as  to  compel  him  to  stop 
and  support  himself  on  the  nearest  object.  Respiration  generally 

3* 


26  TURNBULL  ON  RANUNCULACE^E. 

unimpeded,  except  under  these  circumstances.  The  circulation  in 
this  patient  is  peculiarly  languid,  the  face  pallid,  and  the  surface  of 
the  body  cold.  The  nervous  system  is  easily  excitable,  and  he 
finds  that  continued  exertion  of  mind  very  much  aggravates  all  his 
symptoms.  Appetite  good,  digestion  easy,  but  occasonially  ac- 
companied by  flatulence;  bowels  rather  costive. 

In  the  previous  treatment  of  this  case  the  same  measures 
were  employed  as  in  those  already  related,  but  without  the  least 
effect.  He  was  ordered  to  take  a  little  opening  medicine  for  a 
week,  and  then  to  apply  the  Veratria  ointment  over  the  region  of 
the  heart  as  usual.  On  the  night  after  the  first  friction  had  been 
used,  the  patient  got  no  rest  in  bed  from  the  excessive  nervous 
irritation  which  it  had  given  rise  to ;  his  feelings  of  anxiety,  and 
palpitation  were  so  much  augmented,  that  he  would  on  no  account 
repeat  the  application:  these  symptoms  continued  unabated  for  two 
days,  at  the  end  of  which  however  the  disease  began  to  decline,  and 
went  on  afterwards  to  do  so  until  every  vestige  of  it  had  disappeared, 
although  no  curative  means  whatever  had  been  employed  after  the 
first  application  of  the  Veratria;  and  he  still  continues  well. 


CASE  IX. 

A  LADY,  about  sixty  years  of  age,  was  seized  with  a  fit  of  fainting 
about  sixteen  years  ago,  in  which  she  continued  for  an  hour  and  a 
half,  and  ever  since  that  occurrence  she  has  been  affected  with  pal- 
pitation of  the  heart,  accompanied  by  frequent  returns  of  the  syn- 
cope. She  now  complains  of  palpitation,  and  difficulty  of  respiration, 
along  with  deep  sighing,  occasioned  by  a  sensation  of  constriction, 
which  she  describes  as  extending  over  the  chest,  but  unattended  by 
cough  ;  and  the  angles  of  the  mouth  are  slightly  bluish  in  appearance. 
The  action  of  the  heart  is  violent  and  irregular,  and  she  complains 
of  oppression  and  weight  over  the  lower  part  of  the  left  side  of  the 
thorax.  The  pulse  is  .intermittent  and  irregular,  and  does  not  at 
all  times  correspond  with  the  intensity  of  the  heart's  pulsations.  She 
complains  of  occasional  shooting  pains  in  the  arm,  reaching  to  the 
points  of  the  fingers;  she  is  sometimes  nervous,  and  low-spirited, 
and  at  intervals  nearly  free  from  all  those  symptoms ;  but  not  for 
any  length  of  time,  for  they  return  again  from  very  slight  causes. 

The  appetite  in  this  patient  is  at  all  times  pretty  good,  but  the 
digestion  is  not  performed  with  a  corresponding  degree  of  facility, 
which  renders  a  careful  selection  of  the  articles  of  diet,  as  well  as 
attention  to  their  quantity,  necessary;  and  notwithstanding  that 
these  precautions  are  attended  to,  there  is  considerable  flatulence 
and  pain  in  the  stomach  during  the  process.  The  bowels  are 
habitually  costive,  and  require  the  employment  of  active  purgatives 
from  time  to  time,  to  keep  them  easy;  and  the  lower  extremities 
are  generally  cold. 

Almost  every  form  of  treatment  that  could  be  devised,  had  in 


EXTERNAL  APPLICATION  OF  VER ATRIA,  ETC.  37 

this  case  been  resorted  to,  during  the  long  continuance  of  the 
disease ;  but  the  palpitations  and  faintings  never  ceased,  although 
the  general  health  by  great  care  had  been  preserved  tolerably  good. 
To  relieve. the  disordered  state  of  the  stomach  and  bowels,  the 
patient  was  now  directed  to  take  opening  medicine,  combined  with 
antacids,  along  with  small  doses  of  blue  pill,  for  a  week ;  and  by 
these  means  the  dyspeptic  symptoms  were,  to  a  certain  extent, 
removed,  but  the  affection  of  the  heart  still  remained  nearly  as 
violent  as  ever.  The  Veratria  ointment  was  then  prescribed  of  the 
usual  strength,  and  ordered  to  be  rubbed  every  night  over  the  left 
side  of  the  thorax.  She  did  not  return  till  the  end  of  a  week  from 
this  time,  and  from  her  own  account,  as  well  as  from  examination, 
she  then  appeared  very  much  better.  During  the  interval  the 
palpitation  and  syncope  had  been  much  relieved,  and  indeed  the 
latter  had  not  returned.  The  feeling  of  tightness  and  oppression 
was  quite  gone;  the  pulse  was  materially  improved  in  character, 
but  still  rather  irregular.  She  was  directed  to  persevere  in  the 
application  of  the  ointment;  her  health  and  appearance  became 
gradually  amended,  and  at  the  end  of  a  month  from  the  time  at 
which  the  Veratria  was  had  recourse  to,  she  was  quite  well. 

External  Application  of  Veratria  in  Neuralgic  Affections. 

IN  no  class  of  diseases  have  the  beneficial  effects  of  the  Veratria 
ointment  been  more  strikingly  manifested  than  in  that  which  it  is 
now  proposed  to  bring  under  consideration  ;  for  in  none  are  the 
symptoms  productive  of  more  distress  to  the  patients,  and  by  no 
other  means  can  the  same  degree  of  relief  be  afforded  in  so  short  a 
period. 

The  external  application  of  the  Veratria  has  been  made  use  of  in 
neuralgic  affections  situated  in  every  part  of  the  body  ;  it  is,  how- 
ever, in  tic-douloureux  that  the  most  remarkable  and  speedy 
change  is  effected  in  the  state  of  the  patient,  for  sometimes  during 
the  continuance  of  the  first  friction  the  paroxysm  is  brought  to  a 
termination,  and  does  not  again  return  ;  and  if  this  be  not  the  case, 
the  following  interval  is  at  least  of  greater  length  than  any  that 
may  have  previously  occurred,  and  the  next  accession  of  pain  is 
less  severe,  and  more  easily  removed. 

The  principal  considerations  to  be  attended  to  in  the  employ- 
ment of  Veratria  in  tic-douloureux  are  connected  with  the  part  of 
the  face,  and  the  extent  of  surface,  in  the  which  the  pain  is  situated, 
and  the  length  of  time  the  patient  has  laboured  under  the  disease. 
With  regard  to  the  first  of  these,  it  has  been  found  that  in  cases 
where  the  affection  is  not  confined  to  one  particular  point,  but  has 
extended  itself  along  the  ramifications  of  the  nerve  in  which  it  has 
its  seat,  the  symptoms  may  be  removed  much  more  speedily,  and 
by  means  of  an  ointment  containing  a  smaller  quantity  of  the  Vera- 
tria than  when  the  contrary  is  the  case  ;  and  this  probably  arises 
from  the  circumstance  of  their  intensity  in  such  instances-  being 


28  TURNBULL  ON  RANUNCULACE.E. 

much  less,  and  from  the  surface  under  which  the  disease  is  actually 
situated  being  greater  than  where  one  spot  only  is  affected,  thereby 
affording  an  opportunity  of  making  the  application  over  a  number 
of  affected  points  at  the  same  time. 

In  cases,  too,  of  long  duration,  there  is  more  difficulty  experi- 
enced in  performing  a  complete  cure,  than  in  those  of  a  more  recent 
date  ;  but  this  does  not  appear  to  arise  from  the  ointment  having 
less  power  in  removing  the  existing  paroxysm  in  these  instances 
than  in  others,  for  it  almost  always  affords  immediate  relief,  but 
from  the  habit  of  recurrence  at  stated  intervals  which  its  previous 
long  continuance  seems  to  have  impressed  upon  the  disease  :  even 
this,  however,  may  be  broken  through  by  a  little  perseverance  ; 
and  a  recovery  be  effected,  if  not  as  quickly,  at  least  as  certainly,  as 
in  less  obstinate  cases. 

For  those  forms  of  the  disease  which  have  been  characterised  as 
occupying  the  branches  of  the  affected  nerve,  an  ointment,  made 
with  twenty  grains  of  Veratria  to  an  ounce  of  lard,  must  be  rubbed 
during  the  paroxysm,  over  the  whole  seat  of  the  pain  for  fifteen  or 
twenty  minutes,  or  what  is  better,  until  the  heat  and  tingling  caused 
by  the  friction  have  been  so  great  as  to  produce  an  impression  on 
the  feelings  of  the  patient  equal  to  that  arising  from  the  disease 
itself;*  and  when  such  an  effect  has  been  brought  about,  the  fric- 
tion may  be  discontinued  for  a  short  time,  to  allow  the  irritation 
occasioned  by  it  to  subside,  so  as  to  enable  the  patient  to  form  a 
judgment  of  the  relative  intensity  of  the  pain  now,  compared  with 
what  it  was  before  the  ointment  was  had  recourse  to.  In  many 
instances  the  paroxysm  will  be  found  to  have  been  cut  short ;  but  if 
any  degree  of  uneasiness  remain,  the  part  must  be  again  rubbed  with 
the  ointment  until  the  peculiar  sensations  arising  from  its  use  again 
show  themselves,  and  this  second  application  will,  in  general,  be 
succeeded  by  a  remission  of  the  pain.  Should  an  instance,  however, 
occur  of  such  obstinacy  as  to  resist  this  repetition,  the  patient 
should  still  persevere,  until  the  paroxysm  be  subdued. 

In  the  great  majority  of  cases  to  which  this  form  of  treatment  has 
been  applied,  the  removal  of  the  paroxysm  has  been  readily  effect- 
ed ;  and  those  in  which  a  continuance  of  the  friction,  in  the  manner 
now  recommended,  is  found  necessary,  are  almost  without  excep- 
tion cases  in  which  the  affection  has  been  confined  to  one  point. 

For  the  purpose  of  obtaining  the  full  effect  of  the  Veratria  as  soon 
as  possible  in  such  instances,  it  has  been  used  in  the  proportion  of 
forty  grains  to  an  ounce  of  lard,  and  this  may  be  done  either  from 
the  very  beginning  of  the  treatment,  or  the  quantity  of  the  alcaloid 
may  be  augmented  by  five  grains  in  each  prescription  until  it  attain 
to  that  amount.  The  former  method  is  upon  the  whole  to  be  pre- 
ferred, because  by  it  an  immediate  check  is  put  upon  the  paroxysm 
in  severe  cases,  without  the  necessity  of  continuing  for  a  length  of 
time  the  employment  of  weaker  applications. 

*  Tt  is  of  the  greatest  importance  to  attend  to  this  caution,  as  the  ointment  has 
no  effect  whatever  in  removing  the  disease  unless  these  sensations  are  induced. 


EXTERNAL  APPLICATION  OF  VERATRIA,  ETC.  39 

It  may  notbe  out  of  place  to  repeat  here  the  caution  already  given, 
against  allowing  even  the  most  minute  quantity  of  the  Veratria  to 
come  into  contactwith  the  conjunctiva,  an  accident  which  may  easily 
happen  during  the  application  of  the  ointment  in  affections  situated 
in  the  face  ;  as  such  a  circumstance,  although  it  may  not  be  fol- 
lowed by  danger,  is  nevertheless  productive  of  so  much  irritation 
as  to  make  it  an  object  to  guard  against  its  occurrence. 

The  general  instructions  which  have  now  been  given  regarding 
the  plan  to  be  pursued  in  the  treatment  of  tic-douloureux,  are 
equally  applicable  to  cases  of  neuralgia,  situated  in  other  parts  of 
the  body.  These  last,  however,  are  not  so  difficult  of  removal  ; 
and  do  not,  so  far  as  has  been  hitherto  observed,  require  the 
ointment  made  use  of  to  contain  more  than  twenty  grains  to  an 
ounce  of  lard.  There  is  a  form  of  this  affection  occurring  in  the 
loins,  and  extending  down  the  thighs  of  women  during  the  men- 
strual period,  in  which  the  application  of  the  Veratria  is  found  of 
great  service,  as  affording  an  easy  and  expeditious  means  of  re- 
moving it. 

CASE  I. 

A  LADY,  fifty-five  years  of  age,  has  been  affected  for  the  last 
thirty-six  years  with  tic-douloureux  in  the  cheek,  and  in  the  fore- 
head above  the  eyebrow  on  the  left  side.  From  the  commence- 
ment of  the  disease,  she  has  had  a  paroxysm  generally  once  a  week, 
and  at  no  time  does  she  remember  the  interval  to  have  been  greater 
than  fourteen  days.  Her  sufferings  during  the  continuance  of  the 
attack  have  been  extreme,  and  have  compelled  her  to  confine  her- 
self to  bed  until  its  termination,  and  it  has  never  lasted  a  shorter 
time  than  two  days.  In  the  intervals,  however,  she  has  been  per- 
fectly free  from  pain,  and  her  general  health  has  all  along  been 
tolerably  good. 

It  appeared  from  the  history  of  the  case  given  by  the  patient,  that 
throughout  the  long  course  the  disease  had  already  run,  almost  every 
kind  of  medical  treatment  had  been  put  in  practice  without  giving 
rise  to  any  permanently  good  result);  and  in  consequence  of  this  cir- 
cumstance, and  as  the  symptoms  appeared  to  admit  of  nothing  but 
slight  alleviation,  if  even  that  could  be  procured,  she  was  ordered  to 
keep  the  bowels  open  by  the  use  of  an  aperient  pill,  and  at  the  com- 
mencement of  every  paroxysm  to  take  a  small  dose  of  acetate  of 
morphia,  and  to  repeat  it  every  hour  until  the  pain  abated.  She 
persevered  in  these  means  for  two  months,  and  experienced  con- 
siderable relief ;  but  although  the  violence  of  the  symptoms  was 
moderated,  neither  any  diminution  of  the  length  of  the  attack,  nor 
any  change  in  the  duration  of  the  interval,  could  be  observed. 

Under  these  circumstances,  and  as  the  general  health  of  the  pa- 
tient was  beginning  to  suffer  from  the  employment  of  the  morphia, 
it  was  ordered  to  be  discontinued  ;  and  she  was  directed  to  take 
small  doses  of  strychnia,  for  the  purpose  of  removing,  if  possible,  a 


30  TURNBULL  ON  RANUNCULACE.E. 

paralytic  affection  of  the  levator  muscle  of  the  upper  eyelid,  and  of 
the  left  side  of  the  face,  which  had  come  on  during  the  previous  ex- 
istence of  the  disease.  This  course  was  persevered  in,  until  the 
convulsive  twitchings,  brought  on  by  the  medicine,  became  as  strong 
as  the  patient  could  bear  them,  but  without  producing  any  effect 
upon  the  paralysis. 

Her  health  was  now  much  weaker,  but  her  sufferings  continued 
unabated  ;  and  as  it  became  a  duty  to  call  into  use  any  means 
which  might  afford  even  the  slightest  prospect  of  relieving  the 
violence  of  the  pain,  she  was  directed,  after  the  manner  already 
stated,  to  rub  over  the  forehead  and  on  the  side  of  the  face,  a  por- 
tion of  ointment,  made  with  twenty  grains  of  Veratria  to  an  ounce 
of  lard,  till  every  uneasy  sensation  was  gone.  In  about  fifteen 
minutes  this  effect  was  produced  ;  but  the  paroxysm  again  made  its 
appearance  within  two  hours,  and  by  a  renewal  of  the  friction  for  a 
few  minutes  it  was  again  extinguished,  instead  of  continuing  two 
days,  as  usual. 

To  this  there  succeeded  an  interval  of  perfect  ease  for  ten  days, 
when  the  attack  again  returned,  but  not  by  any  means  so  violently 
as  before.  On  this  occasion  the  same  plan  was  pursued  as  in  the 
preceding  paroxysm,  and  the  relief  afforded  was  still  more  marked, 
for  the  pain  was  entirely  removed  by  the  first  application.  From 
this  time  the  patient  had  only  one  or  two  very  slight  accessions,  but 
these  were  at  once  cut  short  by  the  use  of  the  ointment  for  a  few 
minutes,  and  the  disease  entirely  left  her. 

Not  the  least  remarkable  circumstance  in  this  case  was  the  change 
which  took  place  upon  the  paralysis,  for  immediately  after  the  first 
friction  had  been  made  use  of,  it  was  observed  to  have  diminished 
considerably  ;  and  by  the  time  the  patient  was  cured  of  the  tic- 
douloureux,  it  had  disappeared,  and  has  not  since  in  any  degree 
returned. 

CASE  II. 

MR.  C.,  aged  forty,  has  laboured  for  sixteen  years  under  tic-dou- 
loureux  over  the  right  side  of  the  face  and  forehead,  but  particularly 
along  the  lower  jaw  as  far  as  the  mesial  line,  where  it  terminated  ; 
and  when  the  paroxysms  were  severe,  the  pain  also  extended  itself 
to  the  same  side  of  the  tongue.  During  the  whole  course  of  the 
disease,  this  patient  has  hardly  ever  been  free  from  pain  ;  and  when 
an  interval  of  ease  did  take  place,  his  sufferings  were  renewed  by 
the  slightest  causes,  and  more  especially  by  mastication,  which 
seldom  failed  to  bring  on  an  accession  :  his  general  health  and  appe- 
tite have  been  good,  so  much  so,  that  he  has  frequently  brought  on 
an  attack  by  inattention  to  proper  rules  for  regulating  his  diet  and 
regimen. 

In  the  previous  management  of  this  case,  under  the  supposition 
that  the  pain  might  depend  upon  decayed  teeth,  the  patient  had 
had  several  extracted  without  affording  any  relief.  He  was  then 


EXTERNAL  APPLICATION  OF  VERATRIA,  ETC.  31 

bled,  generally  and  locally  ;  blisters  and  embrocations  were  repe&t- 
edly  employed,  but  still  no  abatement  in  the  severity  of  the  symp- 
toms took  place.  Along  with  these  means  he  had  also  used  large 
doses  of  carbonate  of  iron,  arsenic,  mercury,  opium,  morphia,  sul- 
phate of  quinine,  nux  vomica,  &c.,  without  effect  ;  and  when  he 
came  under  treatment,  he  had  been  taking  prussic  acid  in  a  quantity 
sufficient  to  affect  the  nervous  system,  and  with  as  little  success  as 
from  the  measures  which  had  before  been  resorted  to. 

As  it  appeared,  from  the  history  of  the  case,  that  the  patient  had 
been  in  the  habit  of  indulging  his  appetite  for  food  and  drink  to  a 
considerable  degree,  and  as  his  digestive  organs  appeared  somewhat 
deranged,  he  was  directed  to  take  small  doses  of  blue  pill  with 
Epsom  salts  ;  and  along  with  these  means  the  Veratria  ointment 
was  prescibed,  of  the  same  strength  as  in  the  preceding  instance  ; 
and  from  the  fact  of  there  being  no  distinct  interval  observable 
betwixt  the  paroxysms,  he  was  directed  to  rub  it  over  the  seat  of 
the  pain  twice  a  day,  and  to  renew  the  friction  at  any  other  time 
should  the  attack  come  on. 

In  the  course  of  four  or  five  days  he  returned  very  much  improved 
in  every  way.  His  general  health  appeared  better  ;  the  disease 
had  been  greatly  relieved,  for  instead  of  being  almost  always  pre- 
sent, as  had  been  the  case  for  so  long  a  time,  it  had  been  broken  up 
into  distinct  accessions,  and  these  were  attended  with  comparatively 
little  pain  :  he  was  therefore  directed  to  discontinue  the  regular 
application  of  the  ointment,  and  to  employ  it  only  when  threatened 
with  a  renewal  of  the  paroxysm  :  soon  after  this,  he  gave  up  the 
use  of  the  internal  medicines  which  had  been  prescribed  for  him, 
and  he  went  on  gradually  improving  under  the  influence  of  the 
Veratria  alone  ;  the  intervals  became  longer,  and  the  fits  less  and  less 
painful,  until  at  the  end  of  four  weeks  from  the  time  he  came  under 
treatment,  he  returned  home  perfectly  free  from  pain,  and  I  believe 
has  been  so  ever  since. 

CASE  III. 

A  LADY,  forty-eight  years  of  age,  has  been  affected  with  severe 
tic-douloureux,  situated  in  the  middle  of  the  left  side  of  the  face, 
for  a  period  of  twenty-two  years.  She  has  made  use  of  every 
possible  medicine,  particularly  of  carbonate  of  iron,  which  she  had 
taken  for  three  months  in  very  large  doses,  but  without  experienc- 
ing any  benefit. 

The  paroxysms  are  irregular  in  their  duration,  but  never  shorter 
than  twelve  hours,  and  they  return  generally  at  the  end  of  three 
days,  sometimes  at  the  end  of  a  week,  but  seldom  longer  ;  and 
during  the  interval  she  is  not  altogether  free  from  pain. 

A  short  time  before  this  patient  came  under  treatment  she  had 
an  attack  of  paralysis  ;  from  which,  however,  she  had  recovered, 
with  the  exception  of  a  slight  palsied  appearance  of  the  countenance. 
There  were  no  very  marked  symptoms  of  derangement  in  the  diges- 


32  TURNBULL  ON  RANUNCULACE^E. 

tive  organs,  but  it  was  thought  advisable  to  put  her  under  a  course 
of  medicine  for  a  few  days,  similar  to  that  made  use  of  in  the  last 
case  ;  and  the  Veratria  ointment,  of  the  same  strength,  was  ordered 
to  be  rubbed  on  in  the  usual  manner  when  the  next  paroxysm 
occurred.  This  was  accordingly  done  ;  and  after  the  friction  had 
been  continued  for  a  quarter  of  an  hour,  the  pain  ceased  entirely, 
and  never  came  on  afterwards  in  the  shape  of  a  regular  attack. 

During  five  weeks  from  this  date,  the  disease  appeared  occasion- 
ally in  the  form  of  slight  twinges  of  pain  in  the  part  previously 
affected,  but  these  were  at  once  removed  by  rubbing  on  a  little  of 
the  ointment,  and  at  length  completely  disappeared. 


CASE  IV. 

A  LADY,  about  thirty-five  years  of  age,  has  suffered  most  severely 
and  almost  without  intermission  for  the  last  eighteen  months,  from 
tic-douloureux  in  the  cheek  and  side  of  the  forehead.  She  has, 
during  all  that  time,  been  put  under  the  effects  of  nearly  every 
variety  of  medical  treatment  that  could  be  suggested,  without  pro- 
ducing any  effect  whatever  upon  the  disease  ;  and  the  only  remedy 
which  has  in  any  degree  alleviated  her  sufferings  is  galvanism,  but 
this  also  has  failed  in  producing  any  permanent  benefit. 

This  patient  appeared  to  enjoy  very  good  health  :  so  that,  with- 
out any  other  treatment  being  put  in  practice,  it  was  determined 
upon  at  once  to  try  the  effects  of  the  Veratria  ointment.  She  was 
therefore  ordered  to  rub  over  the  affected  part  in  the  usual  manner 
an  ointment  made  with  twenty  grains  of  Veratria  to  an  ounce  of 
lard,  which  she  accordingly  did,  and  in  ten  minutes  from  the  com- 
mencement of  the  friction,  every  vestige  of  the  pain  had  disappeared, 
and  it  has  never  since  returned. 


CASE  V. 

A  LADY,  twenty-five  years  of  age,  has  been  for  the  last  seven  years 
affected  with  severe  tic-douloureux,  confined  to  one  point,  exactly 
in  the  situation  of  the  supra  orbitary  foramen  of  the  right  side. 
The  paroxysms  have  varied  in  duration,  from  sixteen  hours  to  two 
days  ;  and  intervals,  extending  from  ten  days  to  three  weeks,  but 
never  longer,  have  intervened  between  the  attacks  of  pain,  and 
these,  when  short,  have  generally  been  followed  by  a  recurrence  of 
the  symptoms  in  two  or  three  days. 

In  this,  as  in  the  preceding  cases,  almost  every  means  of  cure 
appeared  to  have  been  already  had  recourse  to,  but,  as  usual,  with- 
out procuring  any  permanent  alleviation  of  the  sufferings  of  the 
patient,  except  that  small  doses  of  acetate  of  morphia  administered 
during  the  paroxysm,  sometimes  caused  an  immediate  cessation  ; 
but  it  was  attended  with  this  inconvenience,  that  if  it  did  not  pro- 


EXTEKNAL  APPLICATION  OF  VERATRIA,  ETC.  33 

duce  the  desired  effect,  all  the  symptoms  were  immediately  aggra- 
vated to  a  great  degree. 

The  digestive  functions  in  this  patient  appeared  to  be  considera- 
bly impaired,  her  circulation  languid,  and  her  extremities  cold, 
especially  during  the  attack.  On  these  accounts  she  was  put  under 
a  course  of  laxatives,  combined  with  blue  pill,  for  about  a  week, 
which  was  the  means  of  removing  these  symptoms,  but  without 
producing  any  change  on  the  disease  itself.  As  it  appeared  that 
carbonate  of  iron  was  almost  the  only  medicine  which  she  had  not 
previously  made  use  of,  it  was  prescribed  in  pretty  large  doses,  and 
persevered  in  until  it  evidently  appeared  to  exercise  no  effect  what- 
ever upon  the  symptoms  ;  it  was  then  given  up,  and  about  six 
weeks  afterwards  the  Veratria  was  applied. 

At  the  commencement  of  one  of  the  accessions,  she  rubbed  over 
the  eyebrow  and  forehead  of  the  affected  side,  part  of  an  ointment 
made  with  twenty  grains  of  the  Veratria  to  an  ounce  of  lard  ;  and 
after  the  friction  had  been  continued  in  the  usual  manner  for  about 
twenty  minutes,  the  paroxysm  was  cut  short.  During  the  interval 
she  was  directed  to  apply,  in  the  same  way,  an  ointment  made  with 
morphia  and  hog's  lard,  in  the  same  proportions  as  the  other,  twice 
a  day,  in  order  to  prevent  a  return  of  the  attack,  but  without  pro- 
ducing the  intended  effect,  for  it  again  made  its  appearance  in  ten 
days. 

With  the  view  of  making  a  decided  impression  at  once  upon  the 
disease,  an  ounce  of  ointment  containing  forty  grains  of  Veratria  was 
ordered  to  be  employed  as  before,  whenever  a  new  accession  of  the 
pain  took  place  ;  and  in  a  few  minutes  after  its  first  application, 
there  followed  a  great  increase  of  the  symptoms,  which  continued 
for  about  two  hours,  and  then  subsided,  leaving  no  trace  of  the  affec- 
tion behind,  neither  has  any  renewal  of  it  taken  place.* 

CASE  VI. 

A  LADY,  aged  twenty-six  years,  who  has  been  subject  to  occasional 
attacks  of  hysteria  since  her  fifteenth  year,  has  also  since  that  period 
suffered  from  tic-douleureux,  situated  in  the  left  eyebrow  and  extend- 
ing itself  up  the  forehead,  in  the  course  of  the  ramifications  of  the  fron- 
tal nerve.  The  paroxysms  in  general  take  place  once  a  month  ;  but 
if  the  patient  happen  to  expose  herself  to  sudden  alternations  of  tem- 
perature, she  is  almost  certain  of  experiencing  a  violent  attack  on 
the  following  day,  and  in  either  instance  it  continues  with  unmitigated 

*  In  this  instance  the  Veratria  has  completely  failed  in  giving  permanent  re- 
lief. The  case  was  drawn  up  about  the  beginning  of  1834,  and  the  patient  was 
at  the  time  in  the  state  above  described ;  shortly  afterwards,  however,  the  disease 
again  showed  itself,  and  has  ever  since  continued  to  come  on  at  intervals.  After 
repeated  examinations,  I  have  been  unable  to  detect  any  organic  disease ;  and 
although  the  other  remedies  mentioned  in  this  volume  have  likewise  been  tried, 
no  permanent  benefit  has  been  derived  from  them. 

JANUARY,  1838. — D  4 


34  TURNBULL  ON  RANUNCULACE^. 

severity  for  about  twelve  hours,  and  not  unfrequently  terminates  in 
sickness  and  vomiting,  occurring  at  intervals  for  two  days  after, 
along  with  a  considerable  degree  of  intolerance  of  light. 

As  no  plan  of  treatment  which  she  had  hitherto  made  trial  of,  had 
had  any  effect  upon  the  disease,  she  was,  without  any  othermeans  being 
employed,  directed  to  rub  at  the  beginning  of  one  of  the  accessions, 
part  of  an  ointment  of  the  usual  strength,  and  in  the  manner  already 
described,  over  the  seat  of  the  pain,  and  to  continue  the  friction  until 
relief  was  obtained.  She  did  so,  and  in  less  than  half  an  hour  from 
the  time  the  ointment  began  to  be  used,  the  paroxysm  entirely  left 
her. 

On  account  of  the  presence,  in  this  case,  of  considerable  visceral 
derangement,  the  patient  was  treated  by  gentle  laxatives,  for  a  short 
time  in  the  way  recommended  in  those  previously  mentioned,  and 
she  was  ordered  to  repeat  the  friction  with  the  Veratria  whenever 
the  pain  returned  ;  but  it  has,  I  believe,  never  since  been  found 
necessary. 

CASE  VII. 

A  LADY,  thirty  years  of  age,  has  been  for  several  years  labouring 
under  tic-douloureux,  seated  in  the  right  orbit,  and  extending  along 
the  course  of  the  frontal  nerve  as  far  as  the  top  of  the  head.  The 
paroxysms  have  been  so  violent  as  generally  to  confine  her  to  bed 
for  a  day  or  two  at  a  time,  and  have  made  their  appearance  with  the 
greatest  severity  at  the  menstrual  period,  but  in  other  respects  she 
has  all  along  been  in  the  enjoyment  of  good  health.  She  was  ordered 
to  rub  the  Veratria  ointment,  when  the  attack  came  on,  over  the 
whole  surface  occupied  by  the  pain  until  relief  was  experienced  : 
this  she  accordingly  did  on  the  first  appearance  of  it :  in  a  few 
minutes  it  was  cut  short,  and  never  afterwards  returned. 


CASE  VIII. 

A  GENTLEMAN,  aged  thirty-five,  of  a  spare  habit  of  body,  subject 
to  nervous  feelings,  and  accustomed  to  sedentary  occupations,  has 
for  the  last  seven  years  been  seized  with  excruciating  fits  of  pain, 
confined  to  the  right  half  of  the  head,  and  returning  by  regular 
paroxysms  at  the  end  of  about  every  third  week.  A  short  time 
before  each  attack  comes  on,  he  suffers  much  from  restlessness  and 
irritability,  his  pulse  becomes  augmented  in  frequency,  and  he 
complains  much  of  impairment  of  memory  ;  and  after  it  has  ceased, 
he  does  not  return  to  his  usual  state  of  health  for  two  or  three 
days. 

For  this  affection  he  was  directed,  during  the  paroxysm,  to  make 
use  of  frictions  with  the  Veratria  ointment,  of  the  usual  strength, 
over  the  seat  of  the  pain  ;  he  first  applied  it  to  the  forehead,  and  one 
rubbing  was  all  that  was  requisite  to  remove  the  pain  in  that  situa- 


EXTERNAL  APPLICATION  OF  VERATRIA,  ETC.  35 

tion,  but  it  still  continued  unabated  in  violence  in  the  remainder  of 
the  affected  region  :  to  this  part  he  was  also  ordered  to  apply  the 
ointment  ;  and  the  pain  there,  in  like  manner,  yielded  to  one  appli- 
cation :  no  return  of  the  symptoms  has  taken  place,  and  he  is  now 
in  good  health. 

Along  with  the  hemicrania,  there  existed  in  this  patient  a  consi- 
derable degree  of  irritability  of  the  heart  ;  but  a  few  frictions  with 
the  same  ointment,  made  over  the  left  side  for  five  minutes  every 
night,  along  with  an  occasional  aperient  pill,  sufficed  to  remove  this 
symptom  permanently. 


CASE  IX. 

MRS.  F.,  about  thirty-eight  years  of  age,  had  for  the  period  of 
four  years  suffered  from  intense  pain,  confined  to  one  spot  in  the 
loins,  and  which  was  not  increased  by  motion.  It  came  on  in 
paroxysms,  so  frequent  in  occurrence,  and  of  such  duration,  that  she 
never  experienced  a  longer  interval  than  two  days  betwixt  them  ; 
and  her  sufferings  were  augmented  to  such  a  degree  during  the 
period  of  gestation,  that  she  was  compelled  to  confine  herself  to  bed 
for  a  great  part  of  the  time. 

To  bring  about  the  removal  of  this  affection,  the  patient  had  pre- 
viously submitted  to  bleeding,  generally  and  locally  ;  and  blisters, 
tartar  emetic  ointment,  frictions  with  stimulating  embrocations, 
along  with  plasters  of  various  kinds,  but  without  in  any  degree  allevi- 
ating the  pain  :  she  had  also  taken  internally  almost  every  medicine 
calculated  in  any  way  to  procure  an  abatement  of  the  disease,  but 
still  no  relief  could  be  obtained. 

When  this  patient  first  put  herself  under  treatment,  several  of 
the  remedies  previously  had  recourse  to  were  again  employed  ;  and 
along  with  these,  frictions  with  croton  oil  were  ordered  over  the 
seat  of  the  pain,  until  a  free  eruption  came  out,  but  without  effect. 
As  a  last  resource,  the  Veratria  ointment  made  with  twenty  grains 
to  an  ounce  of  lard,  was  directed  to  be  applied  in  the  usual  way, 
and  in  a  very  few  minutes  every  vestige  of  the  pain  had  disappeared. 
She  has  been  since  entirely  free  from  it,  and  is  now  in  the  enjoy- 
ment of  the  best  health. 


CASE  X. 

A  YOUNG  lady,  about  twenty-four  years  of  age,  has  been  affected 
with  most  violent  pains  in  the  loins  and  thighs,  during  the  men- 
strual period,  for  about  eight  years.  The  pain  has  in  general  con- 
tinued, without  intermission,  for  three  days,  and  has  then  subsided 
of  its  own  accord. 

Many  attempts  have  been  made  in  this  case  to  effect  a  cure  ;  the 
patient  has  taken  opium,  preparations  of  morphia,  Dover's  powder, 


36  TURNBULL  ON  RANUNCULACE^E. 

and  other  sedative  remedies,  but  without  experiencing  any  permanent 
benefit,  for  at  each  monthly  period  the  pain  has  manifested  itself 
with  the  same  severity  as  before.  From  the  effects  which  the 
Veratria  had  been  already  observed  to  have  upon  similar  diseases, 
an  ointment  made  with  twenty  grains  of  the  alcaloid  to  an  ounce  of 
lard,  was  directed  to  be  made  use  of  over  the  loins,  with  the  effect 
of  immediately  removing  the  pain,  and  it  has  not  again  returned. 


CASE  XI. 

THE  eleventh  case  happened  in  a  lady  about  thirty-three  years 
of  age  ;  and  except  that  the  disease  had  in  this  instance  continued 
for  nine  years,  its  previous  history,  course,  and  termination,  were 
so  precisely  similar  to  those  of  the  preceding  case,  that  any  more 
particular  relation  appears  unnecessary. 


CASE  XII. 

AN  elderly  gentleman,  rather  corpulent,  and  of  sedentary  habits, 
had  suffered  severely  for  nine  months  from  a  fixed  pain  seated  in 
the  lower  part  of  the  spine.  It  had  continued  during  the  whole 
time  almost  without  intermission,  and  at  last  nearly  prevented 
him  from  remaining  in  the  erect  posture.  The  Veratria  ointment 
was  directed  to  be  rubbed  over  the  affected  part,  and  immediately 
removed  the  pain  ;  the  patient  was,  however,  ordered  to  apply  the 
frictions,  night  and  morning,  for  two  weeks,  to  prevent  a  return, 
and  he  has  since  had  no  symptoms  of  the  complaint. 


CASE  XIII. 

MRS.  A.,  a  middle-aged  lady,  has  suffered  severely  for  about  five 
years  from  a  painful  affection  in  the  situation  of  the  os  coccygis, 
which  is  much  increased  by  sitting,  or  riding  on  horseback.  For 
the  cure  of  this  disease,  she  has  been  under  every  variety  of  treat- 
ment, both  internal  and  external,  and  has  spent  much  time  at  the 
principal  watering-places,  but  the  pain  has  continued. 

She  was  directed  to  make  use  of  friction  with  the  Veratria  oint- 
ment over  the  affected  part,  and  the  first  application  afforded  com- 
plete relief.  At  the  end  of  twelve  hours  the  pain  again  came  on, 
but  was  a  second  time  as  easily  removed  ;  and  as  there  seemed  to 
be  a  tendency  to  a  recurrence  of  the  symptom,  the  ointment  was 
ordered  to  be  repeated  night  and  morning,  until  the  disease  had 
ceased  again  to  appear.  In  the  course  of  ten  days  the  patient  was 
quite  well,  and  has  since  continued  to  be  so. 


APPLICATION  OF  VERATRIA  IN  RHEUMATISM.  37 


External  Application  of  Veratria  in  Rheumatism. 

FROM  what  has  been  said  in  the  foregoing  chapter  on  the  subject 
of  the  external  employment  of  Veratria  in  neuralgia,  it  will  not  be 
requisite  to  introduce  here  any  further  remarks,  except  such  as  are 
exclusively  applicable  to  the  effect  produced  by  it  upon  rheumatism 
in  its  various  forms. 

In  the  acute  form  of  the  disease,  the  Veratria  ought  not  to  be 
employed,  if  there  be  active  inflammation  going  on  in  the  affected 
parts  ;  as  it  is  much  better  to  treat  the  acute  symptoms  in  the  usual 
manner  ;  but  when  these  are  on  the  decline,  the  ointment  may  be 
had  recourse  to  with  advantage. 

From  the  extent  of  surface  affected  in  acute  rheumatism,  and 
from  the  quantity  of  ointment  which  is  on  that  account  required 
for  the  friction,  the  proportion  of  Veratria  ordered  in  the  prescrip- 
tion should  not  be  so  great  as  in  the  diseases  already  treated  of;  for 
in  this,  as  in  other  affections,  the  strength  of  the  ointment  should 
always  bear  a  certain  relation  to  the  space  over  which  it  is  to  be 
applied. 

In  cases  where  the  rheumatism  is  general,  or  where  it  is  seated 
in  several  joints  at  the  same  time,  ten  grains  of  Veratria  to  an  ounce 
of  lard  will  make  an  ointment  sufficiently  powerful  for  every  pur- 
pose ;*  but  where  it  is  confined  to  one  or  two  joints,  or  where  it 
has  assumed  the  chronic  form,  the  quantity  employed  may  be 
varied  according  to  circumstances,  from  ten  to  twenty  or  more 
grains,  and  the  friction  may  be  continued  in  either  case  as  long  as 
the  patient  can  bear  it  ;  or  if  it  be  requisite  to  specify  a  fixed  portion 
of  time — as  a  general  rule,  it  may  be  stated,  that  in  the  earlier 
stages  of  the  disease  fifteen  minutes,  and  in  long  standing  examples 
twenty,  will  be  enough  to  remove  the  existing  pain. 

When  the  case  to  be  treated  is  decidedly  chronic  in  its  nature, 
much  perseverance  is  requisite,  particularly  if  extensive  organic 
changes  in  the  parts  have  taken  place  ;  the  best  directions  are,  to 
rub  the  affected  joints  every  night  for  the  time  specified,  until  the 
pain  has  disappeared  ;  and  at  any  future  period,  when  from  change 
of  weather,  or  other  cause,  it  again  returns.  In  slight  acute  affec- 
tions, arising  from  cold,  one  or  two  applications,  continued  until 
the  heat  and  tingling  manifest  themselves,  often  effect  a  cure. 

The  directions  which  have  now  been  given  will,  in  most  cases, 
prove  sufficient  to  enable  the  practitioner  to  make  use  of  the  Veratria 
ointment  in  the  more  topical  forms  of  rheumatism,  as  well  as  in 
those  already  pointed  out :  and  little  more  appears  requisite  than 
simply  to  enumerate  such  as  it  may  be  applied  in  with  the  most 
evident  advantage. 

In  lumbago,  sciatica,  rheumatic  affections  of  the  muscles  over  the 

*  In  this  form  of  the  disease,  it  will  be  found  advantageous  to  administer  some 
one  of  the  preparations  of  Veratria,  already  recommended,  at  the  same  time  that 
the  frictions  are  used. 

4* 


38  TURNBULL  ON  RANUNCULACEJE. 

chest,  or  in  other  parts,  the  symptoms  may  be  relieved  almost  im- 
mediately by  the  first  friction  ;  and  in  more  obstinate  cases,  a  few 
more  will,  in  general,  have  the  desired  effect. 


CASE  I. 

MR.  G.,  a  gentleman  about  forty-eight  years  of  age,  had  been  for 
some  time  subject  to  occasional  severe  attacks  of  acute  rheumatism, 
affecting  chiefly  the  joints  of  the  extremities,  and  attended  with  a 
considerable  degree  of  general  fever.  For  several  days  before  he 
came  under  treatment  he  had  been  labouring  under  very  acute 
symptoms  of  the  disease ;  he  had  had  a  good  deal  of  fever,  a  quick 
throbbing  pulse,  much  heat  of  skin,  and  the  joints  of  the  elbows, 
wrists,  knees,  and  ankles  were  swollen  red,  and  so  very  painful  as 
to  render  motion  to  any  extent  impossible. 

In  this  case  the  most  active  measures  had  already  been  put  into 
practice.  Venesection  had  been  freely  employed,  he  had  used 
large  and  repeated  doses  of  purgatives,  of  various  diaphoretic  medi- 
cines, and  colchicum  ;  and  along  with  these  means  the  antiphlogistic 
regimen  had  been  carefully  pursued  since  the  commencement  of  the 
attack,  but  no  abatement  in  its  violence  had  taken  place. 

As  everything  likely  to  effect  a  cure  in  the  usual  way  appeared 
to  have  been  resorted  to,  the  previous  internal  treatment  was  ordered 
to  be  persevered  in,  and  at  the  same  time  an  ointment,  consisting  of 
ten  grains  of  Veratria  and  an  ounce  of  lard,  was  directed  to  be 
rubbed  upon  the  affected  joints,  for  ten  minutes  at  night,  and  again 
the  following  morning.  When  the  patient  was  visited  next  day,  his 
rheumatism  was  nearly  gone.  The  ointment  had  occasioned  a  con- 
siderable increase  in  the  heat  of  the  parts,  but  the  inflammation  and 
swelling  were  greatly  diminished,  and  the  pain  almost  removed  ; 
he  could  now  use  the  affected  joints  with  perfect  ease,  and  there 
was  no  return  of  the  symptoms  for  some  days.  He  then  experienced 
a  slight  renewal  of  the  complaint  in  one  of  the  ankles  ;  and  at  the 
very  first  appearance  rubbed  the  ointment,  of  his  own  accord,  over 
the  inflamed  surface  for  the  usual  time,  but  although  it  produced 
sensations  of  heat  and  tingling  as  usual,  yet  no  amelioration  of  the 
pain  took  place  :  the  friction  was  therefore  ordered  not  to  be  repeated 
till  twelve  hours  had  elapsed,  and  at  the  end  of  that  period  one  ap- 
plication entirely  removed  it. 


CASE  II. 

A  BOY,  twelve  years  of  age,  and  of  a  delicate  habit  of  body,  had 
been  labouring  for  three  or  four  days  under  an  attack  of  acute  rheu- 
matism, attended  by  a  good  deal  of  febrile  excitement  ;  the  pulse 
was  quick,  the  skin  hot,  and  the  tongue  dry,  and  slightly  furred  ; 
both  his  ankles  and  knees  were  swollen  to  a  considerable  degree, 


APPLICATION  OF  VERATRIA  IN  RHEUMATISM.  39 

had  a  red  and  inflamed  appearance,  and  could  not  be  moved,  on  ac- 
count of  the  pain. 

On  the  second  day  of  the  disease,  leeches  and  fomentations  had 
been  applied  to  the  affected  joints,  and  internally  he  had  taken  col- 
chicum  and  diaphoretics,  but  with  very  little  benefit.  He  was 
therefore  ordered  to  have  an  ointment  made  with  twenty  grains  of 
Veratria  to  an  ounce  of  lard,  freely  rubbed  over  the  seat  of  the 
pain,  for  about  fifteen  minutes  at  bed  time. 

Next  morning  the  patient  was  almost  well.  During  the  night 
the  pain  and  fever  had  disappeared,  and  he  could  walk  about  and 
move  his  limbs  with  perfect  ease  ;  the  inflammation  and  swelling 
had  to  a  great  degree  subsided,  and  the  joints  were  restored  to 
nearly  their  natural  appearance.  In  two  days  afterwards,  although 
the  ointment  had  been  only  once  applied,  no  trace  of  the  affection 
was  left. 

CASE  III. 

MR.  G.,  forty-five  years  of  age,  and  of  a  robust  constitution,  was 
in  consequence  of  exposure  to  cold  and  wet  seized  with  a  rheu- 
matic attack,  which  was  confined  to  the  knee  and  ankle  of  the  right 
side,  and  accompanied  with  some  degree  of  fever  ;  he  was  ordered 
on  the  evening  following  the  accession  of  the  disease  to  take  anti- 
mony combined  with  calomel  ;  but  next  day  the  symptoms  did  not 
appear  at  all  to  have  diminished.  The  affected  joints  were  swollen, 
inflamed,  and  painful,  and  the  quickness  of  pulse,  and  heat  of  skin 
still  continued  the  same. 

Part  of  an  ointment  made  with  twenty  grains  of  Veratria  to  an 
ounce  of  lard,  was  now  directed  to  be  rubbed  over  the  seat  of  the 
pain  for  the  usual  time  ;  and  on  the  morning  after  the  first  applica- 
tion, the  patient  could  walk  about  the  house  ;  the  pains,  inflamma- 
tion, and  swelling  had  almost  disappeared,  and  the  febrile  symp- 
toms were  gone  :  by  continuing  the  same  treatment  for  two  days 
longer,  he  was  able  to  follow  his  business,  and  no  relapse  afterwards 
occurred. 

CASE  IV. 

MR.  S.,  a  stout  gentleman,  aged  about  fifty,  had  been  in  the  early 
part  of  his  life  much  exposed  to  cold  and  moisture,  which  brought 
on  an  attack  of  lumbago,  and  since  that  time  he  has  had  many  re- 
turns of  the  disease.  In  addition  to  this,  he  has  also  been  affected 
with  chronic  rheumatism,  confined  principally  to  the  joints  of  the 
hip  and  knee  of  the  left  side.  The  motion  in  both  is  very  much 
impeded  ;  over  the  hip-joint  there  is  an  evident  fullness,  and  when 
any  extensive  movement  is  impressed  upon  it  there  is  a  distinct 
crackling  noise  elicited,  and  a  similar  feeling  is  communicated  to 
the  patient. 

The  knee  is  also  the  seat  of  considerable  swelling,  and  pain  which 


40  TURNBULL  ON  RANUNCULACE^S. 

is  increased  by  pressure,  but  particularly  by  attempts  at  motion,  and 
the  same  noise  and  sensation  are  present  when  it  is  bent  and  ex- 
tended as  in  the  hip-joint.  The  swelling  in  both  situations  is  white 
in  appearance,  puffy,  and  somewhat  elastic.  The  sufferings  of  the 
patient  are  much  aggravated  by  change  of  weather  ;  and  attempts 
at  motion  in  the  affected  joints  are  attended  with  so  much  pain  that 
he  is  compelled,  in  walking,  to  lift  the  whole  extremity  without 
bending  it,  by  exerting  the  muscles  of  the  opposite  side. 

For  the  removal  of  the  disease,  he  had  proviously  resorted  to 
most  of  the  remedies  in  common  use.  Besides  having  taken  inter- 
nally every  thing  that  appeared  likely  to  afford  relief,  he  had  em- 
ployed to  the  parts  themselves,  bleeding,  counter-irritation  by  means 
of  blisters,  &c.,  and  embrocations  of  every  kind  ;  all  of  which  had 
failed  in  procuring  any  other  than  a  temporary  abatement  of  the 
symptoms. 

Under  these  circumstances  this  case  first  presented  itself,  and 
with  the  view  of  giving  a  fair  trial  to  external  applications,  the  af- 
fected parts  were  ordered  to  be  rubbed  with  croton  oil  twice  a  day, 
until  a  very  free  eruption  came  out,  and  this  plan  was  followed 
with  considerable  success  for  about  six  weeks,  during  all  of  which 
time  the  irritation  was  kept  up  by  repeated  frictions  with  the  oil. 
Even  this,  however,  at  last  began  to  lose  its  effect  ;  and  the  pain, 
which  had  at  first  diminished  considerably,  now  appeared  to  be 
rapidly  on  the  increase,  and  as  there  was  no  objection  to  the  appli- 
cation of  the  Veratria,  it  was  prescribed. 

An  ointment  made  with  twenty  grains  of  the  alcaloid  to  an  ounce 
of  lard,  was  ordered  to  be  rubbed  for  twenty  minutes  twice  a-day 
over  the  knee  and  hip  of  the  affected  side  ;  and  after  it  had  been 
made  use  of  a  few  times,  the  troublesome  symptoms  began  to  de- 
cline. The  pain  went  quite  away,  and  the  swelling  and  the  rigidity 
became  rather  less  :  so  that  at  the  end  of  ten  days  or  a  fortnight,  the 
patient  could  bend  both  the  diseased  joints,  and  could  walk  almost 
without  inconvenience.  The  disease  itself  is,  of  course,  not  re- 
moved ;  but  he  can  now  take  exercise  on  foot,  and  move  the  articu- 
lations with  freedom. 

In  changeable  weather  a  slight  return  of  the  pain  sometimes  takes 
place,  but  this  is  at  once  removed  by  rubbing  the  part  with  the 
ointment  for  a  few  minutes  ;  and  the  patient  is  now  in  a  comfort- 
able condition. 

CASE  V. 

MR.  B.,a  gentleman  about  forty-five  years  of  age,  was  seized  two 
years  ago  with  an  attack  of  rheumatism  which  terminated  in  a 
chronic  affection  of  the  joints  of  the  right  arm  and  hand.  He  expe- 
renced  great  difficulty  in  making  use  of  the  muscles  of  the  shoulder 
from  the  pain  which  always  attended  upon  any  efforts  at  motion  : 
the  elbow-joint  was  stiff  and  painful,  and  he  was  obliged  to  carry 
the  fore-arm  in  a  sling.  The  articulations  of  the  fingers  were 


APPLICATION  OF  VERATRIA  IN  RHEUMATISM.  41 

swollen,  and  also  gave  pain  on  motion,  so  that  the  patient  could  not 
use  them  in  writing  ;  but  had  been,  in  consequence,  in  the  habit 
of  employing  the  left  hand  for  that  purpose. 

This  patient  had  previously  applied  many  remedies,  without 
obtaining  benefit  from  them,  and  he  was  now  ordered  to  rub  the 
affected  joints  twice  a  day  with  the  Veratria  ointment  ;  and  in  a 
day  or  two  all  uneasiness  had  left  the  shoulder  and  elbow,  and  he 
could  now  move  the  arm  with  facility.  The  disease  in  the  joints 
of  the  fingers  was  also  much  relieved,  but  the  swelling  appeared 
nearly  the  same  ;  he  was  directed  to  continue  the  application  of 
the  ointment  to  them  occasionally,  until  it  produced  some  effect.  He 
returned  at  the  end  of  about  six  weeks,  and  at  that  time  the  pain 
and  swelling  had  disappeared,  and  he  had  recovered  the  entire  use 
of  the  hand. 

CASE  VI. 

MRS.  P.,  about  fifty-two  years  of  age,  has  been  for  the  last  twelve 
years  affected  with  chronic  rheumatism  in  the  joints  of  the  inferior 
extremities,  but  particularly  in  the  hip  and  knee  of  the  right  side. 
Her  sufferings  for  a  considerable  time  have  been  augmented  by 
variations  in  the  state  of  the  weather  ;  and,  for  the  last  five  years, 
the  joints  in  which  the  disease  is  situated  have  been  so  painful  and 
rigid,  as  to  oblige  her  to  make  use  of  supports  in  walking  ;  the 
knee  is  much  swollen,  and  gives  a  sensation  of  crepitus  when 
moved. 

In  the  previous  treatment  of  this  case  also,  remedies  of  every 
description  had  failed  to  do  good  ;  and  in  order  to  try  the  effects  of 
the  Veratria,  it  was  directed  to  be  rubbed  on  twice  a  day  in  the 
usual  manner,  and  to  be  persevered  in  for  some  time.  At  the  end 
of  a  fortnight  the  symptoms  were  much  relieved,  and  she  could 
move  the  limbs  with  some  degree  of  ease  ;  she  went  on  improving, 
and  after  six  weeks  could  walk  three  miles  at  a  time  with  little 
difficulty,  and  without  support. 


CASE  VII. 

MR.  K.,  a  gentleman  thirty-five  years  of  age,  has  been  the  sub- 
ject of  repeated  attacks  of  lumbago,  for  several  years,  and  the  pain 
has  occasionally  been  such  as  to  confine  him  to  bed  for  a  fortnight 
at  a  time.  When  the  disease  first  made  its  appearance  the  patient 
was  bled  and  blistered  repeatedly,  and  took  many  remedies  in- 
ternally, but  particularly  colchicum,  and  these  means  were  always 
followed  by  relief. 

During  the  two  attacks  which  had  occurred  previously  to  that  in 
which  the  Veratria  was  used,  he  had  supplied  sinapisms  to  the  seat 
of  the  pain,  and  taken  large  doses  of  colchicum,  with  the  effect  of 
removing  the  symptoms  ;  but  not  till  the  plan  had  been  continued 
for  about  three  weeks. 


42  TURNBULL  ON  RANUNCULACE.E. 

One  evening  he  had  a  return  of  the  affection,  and  when  visited 
next  day,  he  was  lying  in  bed  in  great  pain,  and  could  not  be 
moved  in  any  direction.  An  ointment,  made  with  twenty  grains 
of  Veratria  to  an  ounce  of  lard,  was  immediately  ordered  to  be 
rubbed  across  the  loins  for  fifteen  or  twenty  minutes,  and  to  be 
repeated  at.  night ;  and  in  the  event  of  the  second  friction  failing  to 
procure  relief,  he  was  directed  to  take  fifteen  grains  of  Dover's 
powder,  with  thirty-eight  drops  of  vinum  colchici,  at  bed-time  ; 
this  last  prescription,  however,  he  did  not  find  it  requisite  to  make 
use  of,  and  next  day  he  could  move  himself  about  freely,  and  with- 
out experiencing  any  pain.  To  guard  against  a  recurrence,  he 
persevered  in  the  use  of  frictions  night  and  morning  for  a  few  days  ; 
he  then  discontinued  them,  and  has  since  been  quite  free  from  the 
complaint. 

CASE  VIII. 

THIS  case  was  one  of  severe  sciatica,  occurring  in  a  gentleman 
about  thirty  years  of  age,  and  bearing  a  considerable  resemblance 
in  its  history  to  the  foregoing  :  the  previous  treatment  pursued  was 
much  the  same,  and  in  like  manner  freed  the  patient  from  the 
existing  attack  ;  but  did  little  towards  establishing  a  permanent 
cure.  The  Veratria  ointment  in  one  application  removed  the  pain, 
and  in  a  few  more  completed  the  recovery  of  the  patient. 


CASE  IX. 

A  GENTLEMAN,  thirty-three  years  of  age,  had,  about  eight  years 
ago,  an  attack  of  acute  rheumatism,  during  which  the  larger  joints 
became  affected,  and  after  the  violence  of  the  disease  had  been  sub- 
dued, there  still  remained  a  degree  of  pain  and  swelling  around  the 
articulations  of  the  tarsus  and  ankle,  of  both  sides  ;  and  to  these  symp- 
toms there  has  latterly  supervened  so  much  rigidity  as  to  disable 
the  patient  almost  entirely  from  walking.  When  an  attempt  at 
motion  is  made,  he  is  compelled  to  raise  the  feet  from  the  ground 
without  bending  the  ankle  joints,  and  he  experiences  great  pain  in 
pressing  upon  the  ball  of  the  great  toe. 

In  this  case,  the  patient  was  directed  to  rub  the  Veratria  ointment 
over  the  diseased  parts  twice  a  day  ;  at  the  end  of  a  fortnight  the 
pain  was  gone,  and  the  attack  completely  removed. 


External  Application  of  Veratria  in  Gout. 

IN  the  treatment  of  gout,  Veratria,  both  internally  and  in  the 
form  of  friction,  is  a  remedy  of  considerable  power.  When  ad- 
ministered by  the  mouth,  its  action  upon  the  disease  is  not  at  all 
unlike  that  of  colchicum,  but  rather  more  mild  ;  and  in  cases  where 


APPLICATION  OF  VERATRIA  IN  GOUT.  43 

the  affection  appears  to  be  more  general  in  its  nature,  much  benefit 
will  be  found  to  arise  from  its  exhibition  in  this  manner,  as  well  as 
from  the  ointment.  During  the  height  of  an  acute  attack,  the 
friction  should  not  at  once  be  resorted  to ;  for  in  this  disease,  as  in 
rheumatism,  the  local  remedy  will  be  found  most  advantageous  after 
the  violence  of  the  constitutional  symptoms  has  been  removed,  by 
other  treatment :  in  some  instances,  however,  it  has  been  of  much 
service  when  made  use  of  at  the  time  an  attack  was  threatened,  by 
warding  it  off,  or  making  the  subsequent  stages  less  severe. 

The  general  directions  for  applying  the  Veratria  ointment  in 
gout,  are  nearly  the  same  as  those  already  given  for  its  use  in  rheu- 
matism. Fifteen  or  twenty  grains  of  Veratria  to  one  ounce  of  lard, 
will  be  sufficient  to  begin  with,  and  the  friction  should  be  continued 
until  the  tingling  sensation  be  freely  produced  :  indeed,  the  quantity 
of  ointment  used,  and  the  duration  of  the  friction,  are  of  little 
moment  without  attention  to  this  circumstance. 

In  a  late  work,  Sir  Charles  Scudamore  has  made  some  very 
judicious  remarks  on  the  effects  of  Veratria  ointment,  and  on  its 
manner  of  application  in  gout.  His  experience,  in  most  essential 
particulars,  confirms  what  I  have  myself  observed,  and  as  illustrations 
of  the  utility  of  the  remedy,  I  shall  avail  myself  of  three  of  the 
cases  he  has  given,  and  shall  here  insert  them.* 


CASE  I. 

"  A  LADY,  aged  forty-four,  subject  to  severe  attacks  of  regular 
gout,  in  an  unusually  severe  paroxysm,  derived  great  benefit  from 
the  internal  medicines  which  I  prescribed;  but  she  remained 
entirely  lame,  from  the  tender,  swollen,  and  rather  painful  state  of 
the  ankle-joint  and  foot.  I  directed  the  Veratria  ointment,  in  the 
strength  of  ten  grains  to  the  ounce  ;  and  the  good  effects  of  the  ap- 
plication were  very  quickly  shown.  She  described  that  she  was  in 
considerable  pain  at  the  commencement  of  the  friction,  but  that  it 
abated  at  the  end  of  twenty  minutes,  and  was  exchanged  for  strong 
prickings  like  those  from  electric  sparks,  and  a  remarkable  warmth, 
rather  agreeable  than  the  contrary.  These  sensations  lasted  about 
an  hour.  On  the  following  morning  the  swelling  of  the  ankle  and 
foot  was  much  reduced,  and  allowed  of  standing.  A  further  per- 
severance with  the  remedy  proved  very  beneficial  ;  and  this  lady, 
by  means  of  it,  and  further  general  treatment,  recovered  in  the  most 
favourable  manner." 

CASE  II. 

"  A  GENTLEMAN,  aged  sixty,  one  of  the  greatest  martyrs  to  gout 
that  I  ever  saw,  was  seized  with  sciatica  and  lumbago,  at  the  same 

*  Principles  and  Treatment  of  Gout,  1835. 


44  TURNBULL  ON  RANUNCULACE.E. 

time  that  he  was  affected  with  sharp  gout  in  the  knee.  There  was 
much  error  in  the  state  of  the  biliary  system.  I  prescribed  mer- 
curial evacuants,  sudorifics,  and  sedatives.  After  six  days  of  this 
treatment,  although  improved  in  his  general  condition,  he  com- 
plained of  continued  suffering  from  the  sciatic  nerve,  and  great, 
though  not  equal,  distress  from  the  knee.  The  Veratria  ointment 
was  rubbed  in  upon  each  affected  part.  It  produced  the  sensations 
of  heat  and  electric-like  prickings  for  nearly  an  hour,  and  very 
decidedly  relieved  the  complaint.  It  was  repeated  three  or  four 
times  with  complete  success.  The  skin  became  irritated,  as  if  by  a 
strong  rubefacient,  but  no  sore  followed.  The  patient  was  highly 
gratified  by  the  effects  of  the  remedy." 


CASE  III. 

"  ANOTHER  patient,  too  anxious  for  the  quickest  relief,  used  the 
remedy  on  the  second  day  of  an  attack  of  acute  gout  in  the  foot,  the 
part  not  being  so  exquisitely  tender  as  to  prevent  moderate  friction. 
Active  evacuants  had  been  taken  at  short  intervals  with  full  effect. 
The  proportion  of  the  Veratria  was  ten  grains  to  the  ounce.  No 
particular  sensations  ensued  from  the  friction,  and  no  apparent 
benefit  resulted.  Five  grains  of  Veratria  were  added,  and  the 
friction  was  followed  up  for  a  longer  time.  Now  the  patient  be- 
came very  sensible  of  the  peculiar  sensations  before  mentioned.  On 
the  following  day,  there  was  a  very  manifest  abatement  of  the  gout ; 
and  the  patient  acknowledged  the  improvement.  In  conjunction 
with  its  further  use,  I  prescribed  the  mild  colchicum  aperient  draught 
and  alteratives.  The  recovery  was  uninterrupted,  and  a  favourable 
convalescence  was  established  in  the  course  of  a  fortnight." 

External  Application  of  Veratria  in  Dropsy  and  Paralysis. 

BESIDES  the  diseases  mentioned  in  the  preceding  chapters,  I  have 
employed  the  Veratria  ointment  in  two  others,  Dropsy  and  Paralysis. 
In  my  account  of  Veratria,  several  cases  of  these  are  mentioned  in 
which  friction  with  the  ointment  appeared  to  have  been  of  great 
service  ;  but  although  the  Veratria  most  certainly  acts  as  a  diuretic, 
as  well  as  a  powerful  stimulant  of  the  nervous  system,  subsequent 
consideration  has  made  it  appear  doubtful  whether  or  not  the  amount 
of  effect  produced,  was  not  augmented  by  the  other  treatment 
pursued  at  the  same  time.  The  subject,  however,  is  open  to  in- 
vestigation, and  on  this  account  I  shall  give  such  genernal  directions 
for  the  use  of  the  ointment  in  these  diseases,  as  may  be  sufficient 
for  such  as  may  wish  to  try  its  effects,  leaving  it  to  future  experience 
to  decide  upon  the  utility  of  the  treatment. 

In  dropsical  cases  it  is  indispensably  necessary  before  the  Veratria 
be  applied,  that  every  attention  should  be  paid  to  all  the  organs, 
upon  a  derangement  of  which,  either  in  structure  or  friction,  the 


APPLICATION  OF  VERATRIA  IN  DROPSY,  ETC.  45 

effusion  may  depend,  otherwise  the  anticipated  effects  may  not  be 
produced. 

If,  after  a  careful  examination,  nothing  wrong,  of  importance,  can 
be  detected,  the  ointment  may  then  be  had  recourse  to  ;  but  if  the 
contrary  be  the  case,  the  diseased  state,  whatever  that  may  be, 
should,  if  possible,  be  first  removed,  and  then  the  treatment  may  be 
proceeded  with. 

The  same  rule  before  laid  down,  as  to  the  relation  which  the 
strength  of  the  ointment  ought  to  bear  to  the  extent  of  surface 
over  which  it  has  to  be  rubbed,  and  to  the  state  of  the  patient,  must 
here  be.  kept  in  mind.  But  as  the  frictions  should,  if  possible,  be 
made  over  the  whole  surface  under  which  the  effusion  exists,  and 
as  this  must  vary  with  the  situation  and  extent  which  it  occupies, 
it  is  evident  that  no  prescription  applicable  in  every  instance  can 
be  given,  except  that  the  quantity  of  the  ointment  rubbed  in  each 
time,  should  not,  in  adults,  contain  less  than  two,  nor  more  than 
four  or  five  grains  of  Veratria;  and  the  friction  should  be  continued 
for  about  twenty  minutes,  and  repeated  once  or  twice  a-day.  If 
the  plan  of  treatment  is  to  be  of  service,  the  diuretic  effect  will 
probably  show  itself  in  a  few  hours,  and  the  repetition  of  the  friction 
must  be  regulated  by  the  effect  produced. 

As  an  illustration,  the  following  case  may  be  introduced,  leaving 
it  for  others  to  judge  whether  the  rapid  disappearance  of  the  watery 
effusion  was  the  result  of  the  large  quantity  of  diuretic  medicine 
the  patient  had  previously  taken,  or  whether  it  arose  from  the  action 
of  the  Veratria. 

J.  Burnell,  Esq.,  of  Theresa  Lodge,  Pocklington,  near  York,  aged 
thirty,  came  under  treatment  in  the  summer  of  1830.  About  a  year 
previously,  he  was  attacked  with  ascites,  which  proved  so  very 
obstinate  that,  although  he  was  put  under  almost  every  plan  of  treat- 
ment which  could  be  devised  by  his  medical  attendants,  during  nearly 
the  whole  time,  the  disease  suffered  no  abatement,  but  on  the  contrary 
appeared  to  be  increasing  rapidly.  At  the  time  he  presented  him- 
self, the  dropsy  had  become  general  ;  his  lower  extremities  and 
scrotum  were  swollen  to  an  enormous  size  ;  the  abdomen  was  com- 
pletely distended  with  fluid ;  and  the  organs  within  the  chest  were 
much  impeded  in  their  functions.  There  was  great  difficulty  of 
breathing,  attended  with  cough  and  slight  watery  expectoration  ; 
the  pulse  was  small  and  intermittent,  and  the  patient  was  unable  to 
remain  in  the  horizontal  posture  for  one  minute,  without  experiencing 
the  most  distressing  sense  of  suffocation  ;  the  distension  of  the  legs 
increased  to  such  a  degree  that  serous  fluid  oozed  from  them  ;  and 
altogether,  the  case  was  one  of  the  most  severe  ever  witnessed. 

The  previous  treatment  of  this  case  had  been  as  active  as  possible  ; 
diuretics  and  drastic  purgatives  of  almost  every  kind  had  been  em- 
ployed, without  producing  any  other  effect  than  weakening  the 
patient;  and  a  course  of  mercury,  continued  during  some  time,  had 
been  equally  unsuccessful.  The  flow  of  urine  was  lessrthan  an  En- 

JANUARY,  1838.— E  5 


46  TURNBULL  ON  RANUNCULACE.E. 

glish  pint  in  twenty-four  hours ;  and  could  not  by  any  means  be  made 
to  exceed  that  quantity. 

For  six  weeks  after  he  came  under  treatment,  the  plan  pursued 
was  similar  to  the  one  already  described.  Mercury,  squill,  the  ace- 
tate and  super-tartrate  of  potass,  digitalis,  colchicum,  spirit  of  nitrous 
ether,  juniper,  broom  seed,  &c.  were  all  had  recourse  to  without 
the  slightest  benefit,  and  the  same  want  of  success  attended  the 
exhibition  of  elaterium, gamboge,  and  other  drastic  purgatives  ;  these 
last  produced  large  watery  stools,  but  without  bringing  about  any 
apparent  diminution  of  the  swelling.  There  now  appeared  no  hope 
of  recovery  :  all  the  means  likely  to  procure  relief  had  been  put  in 
force,  and  had  only  added  to  the  distress  and  debility  of  the  patient, 
so  that  it  became  necessary  to  abandon  them,  and  look  out  for  some 
other  means  of  cure. 

In  this  emergency  it  was  resolved  upon  to  make  trial  of  the  Ve- 
ratria  externally,  and  a  box  of  ointment,  made  with  four  grains  of 
the  alcaloid  and  an  ounce  of  lard,  was  accordingly  directed  to  be 
rubbed  over  the  surface  of  the  abdomen  at  bed-time.  The  whole 
quantity  was  applied  ;  and  in  the  course  of  the  night,  and  following 
morning,  the  patient  evacuated  no  less  than  eight  pints  of  urine, 
which  had  caused  a  marked  diminution  of  the  swelling,  both  in  the 
abdomen  and  extremities,  and  was  attended  with  considerable  relief 
to  the  breathing  and  circulation  ;  but,  along  with  these  effects,  the 
medicine  had  caused  such  an  alarming  prostration  of  strength  as  to 
render  the  administration  of  stimulants  absolutely  necessary,  for 
three  days  before  the  ointment  could  be  repeated  ;  at  the  end  of  that 
time,  when  the  patient  appeared  somewhat  recovered  from  his  weak- 
ness, a  fresh  quantity  was  prescribed,  in  which,  however,  a  less  pro- 
portion of  the  Veratria  was  used,  owing  to  the  violent  constitutional 
symptoms  caused  by  the  first.  On  this  occasion,  two  grains  only 
were  rubbed  on,  yet  the  diuretic  effects  were  scarcely  less  marked 
than  before  ;  and  these  were  again  accompanied  by  a  degree  of 
debility  which,  although  not  so  great  as  in  the  preceding  instance, 
still  made  it  a  matter  of  necessity  to  repeat  the  stimulants,  and  to 
delay  the  third  application  for  five  or  six  days. 

On  both  occasions,  after  the  first  effects  of  the  ointment  had 
subsided,  the  quantity  of  urine  diminished  considerably,  but  the 
swelling  became  daily  less  in  magnitude,  and  the  patient  went  on 
improving  in  a  manner  that  could  not  have  been  anticipated.  On 
the  fifth  or  sixth  day  from  the  second  rubbing,  a  third,  with  an  ounce 
of  ointment  containing  two  grains  of  Veratria,  was  directed  to  be 
made  use  of,  as  before  ;  and  from  this  time  the  dropsy  rapidly  dis- 
appeared ;  the  patient  gained  strength  sufficient  to  enable  him  to  take 
active  exercise  ;  and  at  the  end  of  three  weeks  from  the  first  applica- 
tion of  the  Veratria,  he  was  completely  cured,  and  has  since  had  no 
return  of  the  disease. 

The  only  collateral  treatment  employed  in  this  case,  along  with 
the  Veratria,  consisted  in  the  daily  exhibition  of  purgative  medicine, 
not  with  the  view  of  producing  any  change  upon  the  disease  by  its 


PROPERTIES  OF  THE  VERATRIA  OF  COMMERCE.  47 

means,  but  only  for  the  purpose  of  obviating  the  constipating  effects 
of  the  remedy. 

In  paralysis,  the  Veratria  is  worthy  of  a  further  trial ;  but  my  late 
experience  with  it  does  not  warrant  the  assertion  that  it  is  a  decid- 
edly useful  remedy.  In  partial  paralytic  cases  it  might  be  used,  and 
probably  with  some  degree  of  advantage,  but  in  severe  cases  it  ap- 
pears to  be  of  as  little  service  as  other  remedies. 

The  friction  ought  to  be  made  along  the  course  of  the  affected  nerves, 
two  or  three  times  a  day,  until  the  tingling  is  produced  ;  but,  as  a 
general  direction,  fifteen  or  twenty  grains,  to  an  ounce  of  lard,  will 
be  strong  enough  ;  and  frictions  of  ten  to  twenty  minutes'  duration 
each,  will  be  sufficient  for  the  purpose  of  giving  it  a  trial.  The 
tincture  of  Sabadilla,  however,  is  a  much  betterremedy  and  certainly 
deserves  the  preference. 

Properties  of  the  Constituents  of  the  Veratria  of  Commerce. 

IT  has  been  already  stated,  that  M.  Couerbe  has  succeeded  in  ob- 
tainingfouralcaloids  from  the  Veratria  of  Commerce,  viz.,  Veratrine, 
Veratrin,  Sabadilline^  and  the  Mono-hydrate,  or  Gum  Resin  of 
Sabadilline  ;  we  have  also  described  the  processes  by  which  these 
substances  may  be  procured  separately,  and  shall  now  give  a  few  fur- 
ther particulars  of  their  history  and  properties. 

VERATRINE. — M.  Couerbe  considers  Veratrine  as  the  pure  active 
principle  upon  which  the  properties  of  Sabadilla  seeds  depend.  It 
is  white,  solid,  and  friable  ;  insoluble  in  water,  but  very  soluble  in 
alcahol  and  ether,  and  forms  crystallizable  salts  with  acids.  Its 
medical  properties,  may  be  considered  precisely  similar  to  those  of 
Veratria. 

VERATRIN. — This  substance  has  a  brown  colour,  it  is  insoluble 
in  water,  and  differs  from  the  preceding  in  being  insoluble  in 
ether.  It  is  soluble  in  alcohol ;  with  nitric  acid,  it  forms  oxalic  acid. 
Its  medicinal  action  has  not  been  tried,  but  may  be  inferred  to  be 
similar  to  that  of  Veratria. 

SABADILLINE. — When  in  a  state  of  purity,  Sabadilline  is  white 
and  crystalline  ;  it  is  very  acrid  to  the  taste,  it  is  completely  soluble 
in  water  and  in  alcohol,  but  insoluble  in  ether  ;  it  combines  with 
sulphuric  acid,  and  forms  a  crystallizable  sulphate.  It  is  distinguish- 
ed from  Veratria  by  its  solubility  in  water,  by  its  insolubility  in 
ether,  and  by  its  forming  crystals.  The  Sabadilline  which  I  have 
employed,  is  in  the  form  of  a  fine  light  brown  powder,  and  not  so 
pure  as  that  obtained  by  M.  Couerbe.  In  this  state  it  is  very  solu- 
ble in  water  and  alcohol,  but  insoluble  in  ether,  and  has  the  following 
properties. 

Its  taste  is  acrid  but  not  bitter,  and  it  produces  a  slight  sensation 
of  cold  when  first  applied  to  the  tongue  ;  when  applied  to  the  nos- 
trils it  irritates  the  mucous  membrane  and  occasions  sneezing,  but 
not  so  violently  as  Veratria.  When  administered  internally  in  the 
dose  of  one-sixth  part  of  a  grain,  every  two  hours,  it  gives  rise  to 
effects  very  similar  to  those  produced  from  the  administration  of 


48  TURNBULL  ON  RANUNCULACEJ3. 

Veratria  and  its  salts,  though  in  a  much  less  degree.  It  excites  a 
little  heat  in  the  stomach,  but  does  not  act  upon  the  bowels,  and  after 
several  doses  have  been  taken  it  occasions  sensations  of  tingling  in 
the  extremities,  but  very  slightly.  Internally  it  has  effects  on  dis- 
ease similar  to  those  of  Veratria,  but  it  is  much  inferior  as  a  medicinal 
agent. 

When  used  in  the  form  of  embrocation  or  ointment,  Sabadilline 
has  more  powerful  effects.  It  excites  a  peculiar  feeling  of  heat  and 
pulsation  in  the  part  where  it  is  rubbed,  and  this  is  accompanied  by 
a  sensation,  as  if  the  part  had  been  severely  bruised,  which  continues 
often  for  some  hours. 

The  ointment  employed  may  contain  from  fifteen  to  twenty  grains 
to  an  ounce  of  lard,  and  may  be  rubbed  for  fifteen  or  twenty  minutes, 
or  until  the  heat  and  pulsation  show  themselves;  sometimes  a  slight 
eruption  comes  out  on  the  skin  where  it  is  rubbed,  but  it  is  not  at- 
tended with  an  inconvenience.  I  have  used  the  ointment  of  Saba- 
dilla  in  friction,  in  neuralgic  affections,  and  in  rheumatism,  gout,  &c. 
Its  effects  are  similar  to  those  of  Veratria,  but  not  so  beneficial.  It 
cannot,  however,  be  said  that  the  remedy  has  had  a  fair  trail,  as  very 
little  of  it  has  as  yet  been  made,  and  what  I  have  used  has  not  been 
in  a  state  of  purity. 

MONO-HYDRATE  OP  SABADILLINE  differs  nothing  in  general  cha- 
racter from  Sabadilline,  except  that  it  has  a  yellowish  colour,  and  is 
incrystallizable  ;  it  has  nearly  the  same  chemical  constitution,  and 
indeed  M.  Couerbe  considers  the  two  substances  as  differing  in 
nothing,  except  that  Sabadilline  has  two  atoms  of  water  of  crystalli- 
zation, whilst  the  mono-hydrate  has  only  one.  From  their  similari- 
ty in  these  respects  it  may  be  inferred  that  they  have  similar 
medical  properties,  although  the  mono-hydrate  has  not  hitherto  been 
used. 

The  only  thing  connected  with  this  part  of  the  subject  which 
remains  to  be  noticed,  is  the  use  of  the  salts  of  Veratria  externally. 
Several  of  these  have  been  employed,  and  appear  to  be  possessed  of 
effects  very  similar  to  those  of  the  base  itself.  Either  the  sulphate, 
acetate,  or  tartrate,  may  be  used,  in  the  proportion  of  from  ten  to 
fifteen  grains  to  an  ounce  of  lard  ;  they  make  an  ointment  that  oc- 
casions a  powerful  sensation  of  heat  and  tingling,  when  rubbed  upon 
the  skin,  and  may  be  resorted  to,  and  perhaps  with  advantage,  when 
Veratria,  as  sometimes  happens,  has  become  less  efficacious  from 
continued  use. 


CHAPTER   II. 

Medicinal  Employment  of  Delphinium  Staphisagria,  and  its 
•Active  Principle,  Delphinia. 

STAVESACRE,  a  biennial,  Polyandria  Trigynia,  Linn.  Ranun- 
Juss.  Maltisiliquse,  Linn,  a  native  of  the  south  of  Europe. 


PREPARATION  OF  DELPHINIA.  49 

The  Delphinium  Staphisagria^^  its  active  principle  Delphinia, 
are  the  next  substances  possessed  of  properties  similar  to  those  of 
Veratria,  of  which  I  shall  give  an  account.  The  seeds  of  the  plant 
are  the  part  used  in  medicine  ;  they  are  of  the  size  of  small  peas, 
triangular,  and  sometimes  four  sided  ;  they  are  rough,  wrinkled,  and 
slightly  curved,  dark  coloured  externally,  and  yellowish  white 
within;  their  smell  is  disagreeable, and  their  taste  bitter,  acrid,  and 
burning. 

Stavesacre  seeds  in  some  quantity,  act  upon  animals  as  an  acrid 
irritating  poison  ;  their  effects  are  chiefly  confined  to  the  mucous 
membrane  of  the  stomach,  in  which  they  sometimes  excite  inflam- 
mation ;  but  the  nervous  system  appears  to  suffer  most,  especially  if 
death  come  "on  soon  after  the  poison  has  been  administered.  In  the 
human  subject,  when  taken  internally,  they  excite  vomiting  and  pur- 
ging, and  act  also  as  general  irritants  and  sialogogues. 

Stavesacre  was  at  one  time  employed  as  a  cathartic  and  anthel- 
mintic,  but  is  now  laid  aside,  on  account  of  the  violence  of  its  effects. 
It  is  still,  however,  used  externally  in  infusion  for  the  treatment  of 
skin  diseases,  particularly  scabies,  and,  in  powder  or  ointment  for 
destroying  pediculi.  In  the  form  of  a  concentrated  tincture,  I  have 
employed  it  as  an  embrocation  in  the  treatmentof  rheumatic  affections, 
with  considerable  advantage.  It  causes  sensations  of  heat  and  ting- 
ling, very  similar  to  thosearising  from  the  use  of  Veratria,  and  should 
be  rubbed  until  these  effects  show  themselves. 

Preparation  of  Delphinia. 

DELPHINIA  was  discovered  in  the  seeds  of  the  Delphinium  Sta~ 
phisagria,  by  MM.  Lassaigne  and  Feneulle,  in  the  year  1819.*  It 
may  be  obtained  by  several  processes,  but  that  recently  given  by  M. 
Couerbe  appears  to  afford  the  purest  result.  It  is  as  follows.  A 
saturated  tincture  of  Stavesacre  seeds  is  to  be  evaporated  to  the 
consistence  of  a  thin  extract,  and  treated  with  water,  acidulated  by 
sulphuric  acid  :  this  solution,  when  filtered,  is  to  be  precipitated  by 
ammonia.  The  precipitate,  after  being  freed  from  its  water,  is  to  be 
taken  up  with  alcohol,  and  again  reduced  to  the  consistence  of  extract, 
which  is  likewise  to  be  dissolved  in  acidulated  water  ;  to  this  solu- 
tion, when  filtered,  a  small  quantity  of  nitric  acid  is  to  be  added,  as 
long  as  any  precipitate  falls  :  the  liquid  freed  from  this  precipitate  is 
again  to  be  thrown  down  by  ammonia,  and  the  powder  dried.  This 
is  the  Delphine  of  Commerce  ;  but,  like  Veratria,  it  is  a  compound 
substance,  and  consists  of  resinous  matter,  Staphisaire,  and  Del- 
phine: the  Delphine  is  separated  by  treating  the  powder  with  ether, 
which  takes  it  up  and  leaves  the  Staphisaire. 

When  in  a  state  of  purity,  Delphinia  is  white,  pulverulent,  and 
without  smell  ;  but,  like  Veratria,  when  applied  to  the  mucous 
membrane  of  the  nose,  it  occasions  sneezing,  along  with  an  abun- 

*  Annales  de  Chimie,  torn.  xi.  xii. 
5* 


50  TURNBULL  ON  RANUNCULACE^E. 

dant  secretion  of  mucous  ;  its  taste  is  at  first  bitter,  and  afterwards 
acrid  ;  and  it  acts  upon  animals  in  the  same  manner,  but  more  ener- 
getically than  the  seeds  from  which  it  is  prepared. 

When  heated  it  melts,  and  somewhat  resembles  wax  in  appear- 
ance ;  and  on  cooling,  it  becomes  brittle  like  resin.  It  is  very 
sparingly  soluble  in  water,  but  yet  in  sufficient  quantity  to  commu- 
nicate a  bitter  taste  to  the  fluid.  In  alcohol  and  ether  it  dissolves 
readily,  and  these  solutions  have  the  property  of  rendering  syrup 
of  violets  green,  and  of  restoring  the  blue  colour  of  litmus,  when 
reddened  by  the  addition  of  a  portion  of  acid.  It  combines  readily 
with  acids,  and  forms  neutral  salts,  which  are  possessed  of  much 
bitterness  and  acridity,  and  it  may  be  precipitated  from  solutions 
of  these  in  the  form  of  a  jelly,  by  the  addition  of  an  alkali. 

Internal  Administration  of  Delphinia  and  its  Salts. 

PURE  Delphinia  has  little  effect  upon  the  mucous  membranes  of 
the  stomach  and  bowels.  It  may  be  administered  in  some  cases  to 
the  extent  of  three  or  four  grains  a  day,  in  doses  of  half  a  grain 
each,  without  exciting  vomiting  ;  in  this  quantity,  however,  it 
sometimes  operates  upon  the  bowels,  but  causes  very  little  irrita- 
tion. In  most  instances  it  acts  as  a  diuretic,  and  occasions  a  con- 
siderable flow  of  pale  urine.  When  taken  to  the  extent  of  a  few 
grains,  it  gives  rise  to  sensations  of  heat  and  tingling  in  various 
parts  of  the  body,  similar  to  those  whitft  are  produced  by  rubbing 
it  upon  the  skin,  and  its  other  effects  are  very  nearly  the  same  as 
those  of  the  salts  of  Veratria.  The  salts  of  Delphinia  act  much  in 
the  same  manner,  but  there  is  nothing  to  give  them  a  preference  to 
the  alcaloid  itself  :  both  have  been  used  in  the  same  diseases  as  the 
preparations  of  Veratria,  and  appear  to  exercise  a  similar  action. 

External  Application  of  Delphinia. 

DELPHINIA,  when  in  a  state  of  purity,  is  entirely  soluble  in  al- 
cohol and  ether  ;  but  neither  of  these  circumstances  can  be  relied 
upon  as  a  test  of  the  efficacy  of  the  medicine  ;  for,  like  Veratria,  it 
may  have  the  appearance  of  being  almost  chemically  pure,  and  yet 
be  possessed  of  little  activity  in  the  removal  of  the  affection,  for 
which  we  may  wish  to  apply  it.  The  test  already  laid  down,  with 
regard  to  Veratria,  is  the  one  which  should  in  this  instance  be  re- 
sorted to  ;  namely,  that  unless  a  solution  of  Delphinia  in  alcohol,  in 
the  proportion  of  four  grains  to  a  drachm,  occasion  a  distinct  sensa- 
tion of  heat  and  prickling,  when  rubbed  for  three  or  four  minutes 
upon  the  forehead,  the  specimen  ought  not  to  be  used,  for  if  this  be 
not  attended  to,  no  beneficial  effect  will  arise  from  its  application. 

There  are  a  few  points  in  which  Delphinia  differs  from  Veratria, 
in  its  action  upon  the  skin,  which  require  to  be  shortly  noticed. 
Veratria,  when  rubbed  upon  the  cuticle,  produces  a  strong  sensa- 
tion of  tingling,  or  rather  a  feeling  similar  to  that  produced  by  re- 


EXTERNAL  APPLICATION  OP  DELPHINIA.  51 

ceiving  a  succession  of  small  electric  sparks  on  an  uncovered  part  of 
the  body  ;  whilst  Delphinia  gives  rise  to  a  sensation  of  burning,  not 
unlike  that  which  manifests  itself  a  short  time  after  the  application 
of  a  blister ;  but  not  to  an  unpleasant  degree,  unless  the  friction  have 
been  carried  too  far.  They  differ  also  in  the  duration  of  the  effect 
produced,  as  that  caused  by  Delphinia  is  generally  more  powerful 
and  durable  than  when  Veratria  is  used. 

In  the  great  majority  of  instances,  Veratria  may  be  rubbed  upon 
the  skin  for  the  usual  time,  without  causing  any  great  degree  of 
redness  on  the  part  ;  but  in  almost  every  case,  a  blush  pervades  the 
surface,  over  which  the  Delphinia  has  been  applied,  and  this  con- 
tinues during  a  length  of  time,  varying  from  a  few  minutes  to  an 
hour  or  two,  but  in  no  instance,  as  yet  observed,  has  it  gone  on  to 
eruption.  This  property  of  stimulating  the  capillaries  of  the  sur- 
face of  the  skin,  may  add  much  to  the  power  of  Delphinia,  particu- 
larly in  paralytic  cases. 

So  far  as  the  comparative  merits  of  the  two  substances  have  been 
examined,  they  appear  to  be  of  nearly  equal  value  as  medicinal 
agents,  for  in  most  instances  they  seem  to  have  the  same  power  in 
removing  similar  diseases.  There  are  one  or  two  particulars,  how- 
ever, in  which  they  differ,  and  which  in  certain  instances  .may  give 
a  preference  to  the  Delphinia.  The  diseases  in  which  it  has  been 
chiefly  employed,  are  tic-douloureux,  paralysis,  and  rheumatism. 
In  the  first  of  these,  when  the  affection  is  seated  in  the  tongue,  or 
at  the  point  where  the  infra-orbitary  nerve  escapes  from  its  fora- 
men, the  use  of  the  Delphinia  is  to  be  preferred,  because  it  can  be 
applied  to  the  tongue,  or  rubbed  on  the  gums  without  occasioning 
irritation  of  the  mucous  membrane,  a  circumstance  of  great  import- 
ance in  the  treatment  of  these  forms  of  the  disease.  It  appears  also, 
upon  the  whole,  better  adapted  to  the  treatment  of  paralytic  cases 
than  the  Veratria,  but  principally  on  account  of  the  property  just 
mentioned,  which  it  possesses, of  exciting  the  circulation  in  the  dis- 
eased part. 

The  manner  of  applying  Delphinia  is  the  same  as  that  already 
recommended  for  Veratria.  It  may  be  used  either  in  the  form  of 
ointment,  or  in  solution  in  alcohol,  and  the  proportions  to  be  em- 
ployed in  either  case,  may  vary  from  ten  to  thirty  or  more  grains 
to  the  ounce,  according  to  the  severity  of  the  affection,  in  the  treat- 
ment of  which  it  is  to  be  prescribed.  The  duration  of  the  frictions, 
also,  should  be  nearly  the  same  ;  that  is  to  say,  from  ten  to  twenty 
or  more  minutes,  or  what  is  better,  until  the  pungent  sensation 
produced  by  the  rubbing  shows  itself.  In  short,  the  two  substances 
are  so  nearly  alike  to  each  other  in  their  effects  upon  the  system, 
and  in  the  manner  of  their  application,  that  the  instructions  which 
have  been  already  given  in  regard  to  Veratria,  are  equally  appli- 
cable to  Delphinia,  except  that  the  latter  may  be  with  safety  applied 
in  affections  seated  in  the  parts  within  the  cavity  of  the  mouth. 
For  this  purpose  a  solution  in  alcohol  is  preferable,  as  being  less 
objectionable  on  the  part  of  the  patient,  and  it  ought  to  be  rubbed 


52  TURNBULL  ON  RANUNCULACE^E. 

upon  the  mucous  membrane,  over  the  seat  of  the  pain,  until  this 
be  removed,  or  at  least  until  the  peculiar  sensation  produced  by  it 
be  as  powerful  as  can  be  borne  ;  and  the  friction  should  be  repeated 
two  or  three  times  a-day,  according  to  circumstances. 

As  an  illustration  of  the  action  of  Delphinia  in  removing  disease, 
the  following  case  has  been  selected.  It  is  also  interesting,  as  in  its 
treatment  both  remedies  were  resorted  to  ;  and  because  it  proves 
the  utility  of  frictions  with  Delphinia  when  employed  within  the 
mouth. 

CASE. 

Feb.  Sth,  1834. — Mr.  J.  Sears,  Bride  Terrace,  Liverpool  Road, 
Islington,  aged  60,  was  about  seven  years  ago  seized  with  an  acute 
pain  seated  in  the  course  of  the  frontal  nerve,  on  the  left  side  ; 
about  four  years  since  the  affection  extended  itself  to  the  infra-or- 
bital nerve,  and  for  the  last  twelve  months  the  portio-dura  has  also 
become  the  seat  of  the  disease.  Since  the  commencement  of  the 
attack  the  pain  has  continued  with  great  severity,  and  with  occa- 
sional itermissions  of  a  day  or  two,  but  the  sum  of  these  has  not 
amounted  to  above  a  month  in  the  year. 

All  attempts  which  had  been  made  to  give  him  relief  had  failed, 
and  for  three  years  he  had  been  compelled  to  relinquish  his  occupa- 
tions, on  account  of  the  severity  of  his  sufferings.  For  three 
weeks  before  he  came  under  treatment,  he  had  of  his  own  accord 
made  use  of  frictions  with  the  Veratria  ointment  over  the  seat  of 
the  pain,  and  he  states  that  under  its  influence  he  has  experi- 
enced considerable  relief,  and  that  at  times  he  is  quite  free 
from  pain,  although  the  disease  is  not  yet  subdued.  He  was  or- 
dered to  continue  the  frictions  whenever  the  pain  showed  a  ten- 
dency to  return,  with  the  following  ointment  : 

R.— Veratrise      .        .        .        gr.  xvi. 

Axung.  §  ss.  M.  ut  fiat  unguent. 

13th. — The  patient  has  made  use  of  the  ointment  as  directed,  and 
the  pain  has  now  disappeared  from  the  temple,  eyebrow, and  side  of 
the  face,  with  the  exception  of  a  point  exactly  over  the  infra-orbi- 
tary  foramen,  where  fit  still  continues  severe,  and  from  whence 
it  occasionally  darts  to  the  other  parts  which  were  previously  af- 
fected. 

As  the  progress  made  since  he  was  last  seen  was  so  far  satisfac- 
tory, in  order  to  try  the  comparative  effects  of  the  Veratria  and 
Delphinia,  he  was  ordered  to  discontinue  the  former,  and  to  use  in 
the  same  manner  the  following  : 

R. — Delphiniae        .        .        gr.  xvi. 

Axung.  §  ss.  M.  ut  fiat  unguent. 


EMPLOYMENT  OF  THE  GENUS  ACONITUM.  53 

17th. — Since  last  report  he  has  been  improving,  the  pain  in  the 
seat  of  the  infra-orbitary  foramen  has  become  less  and  less  severe, 
and  he  is  at  present  quite  free  from  it.  He  was  ordered  to  use  the 
Delphinia  ointment  if  the  pain  should  return. 

20th. — The  pain  has  never  appeared  except  at  the  point  already 
mentioned.  The  same  prescription  to  be  continued,  with  this 
difference,  that  the  frictions  are  to  be  confined  as  nearly  as  possible 
to  the  skin  over  the  seat  of  the  pain. 

23d. — The  patient  is  better  to-day  than  he  has  yet  been  ;  there 
is  still,  however,  a  tendency  to  a  recurrence  of  the  pain  ;  he  was 
directed  to  discontinue  the  external  use  of  the  Delphinia,  and  in- 
stead of  it,  to  rub  a  portion  of  the  same  ointment  inside  of  the 
mouth,  along  the  angle  formed  by  the  gum  and  cheek,  as  nearly  as 
possible  to  the  situation  of  the  infra-orbitary  foramen,  and  to  con- 
tinue the  friction  until  the  pain  was  removed,  or  as  long  as  the 
application  could  be  borne. 

25th. — The  friction  occasioned  no  irritation  in  the  mucous  mem- 
brane ;  it  gave  rise,  however,  to  a  sensation  of  tingling,  accom- 
panied with  some  degree  of  salivation,  and  the  pain  has  almost  dis- 
appeared. Yesterday  the  patient  had  no  attack,  but  to-day  it  has 
slightly  returned.  He  was  ordered  to  use  the  frictions  to  the  inside 
of  the  cheek  and  gum,  when  the  pain  showed  itself,  with  the  follow- 
ing ointment : 

R. — Delphiniae  ..       gr.  x. 

Axung.       . .         .        3  ii.     M.  ut  fiat  unguent. 

March  llth. — The  last  prescription  was  not  made  use  of,  as  the 
patient  has  continued  to  be  quite  well.  The  slight  pain  he  experi- 
enced when"  last  seen,  disappeared  of  itself  ;  and  with  the  exception 
of  a  little  feeling  of  uneasiness,  which  lasted  only  a  minute  or  two, 
he  has  had  no  symptom  of  his  former  disease.  He  has  resumed 
his  employment  after  an  interval  of  three  years  —  has  exposed 
himself  to  drafts  of  cold  air,  and  to  all  those  causes  which  used 
formerly  to  bring  on  severe  paroxysms  of  pain,  but  up  to  this  date 
(June  1835)  he  has  not  had  the  slightest  appearance  of  a  return* 


CHAPTER   III. 

Medicinal  Employment  of  the  Genus  Jlconilum,  and  its  J$ctive 
Principle  Jlconitine. 

ACONITUM,  Potyandria   Trigynia,  Linn.  Ranunculacese,  Juss, 
Multisiliquae,  Linn.  Europe. 

The  genus  dconitum  has  been  divided  by  De  Candolle  into  four 


54  TURNBULL  ON  RANUNCULACE.E. 

sections, — */Inthora,  Lycoctonum,  Cammarum,  and  Napellus. 
Several  species  have  been  introduced  into  medicine  in  different 
countries,  and  at  various  periods.  An  unknown  species  appears  to 
have  been  used  by  Avicenna,  the  celebrated  Arabian  physician,  in 
the  treatment  of  skin  diseases  ;  but  since  his  time,  down  to  a  com- 
paratively recent  period,  no  further  notice  seems  to  have  been  taken 
of  it  The  person  who  may  be  said  to  have  introduced  Aconite 
into  practice,  was  Dr.  Stork  ;  and  he  recommended  its  employment 
in  the  form  of  inspissated  juice,  prepared  from  the  fresh  plant, 
in  the  treatment  of  Gout,  Chronic  Rheumatism,  Amaurosis,  Syphi- 
lis, &c.* 

Considerable  difference  of  opinion  has  prevailed  as  to  the  precise 
species  made  use  of  by  Stork.  He  himself  names  two  : — the  <flco- 
nitum  Napellus  and  Jl.  Neomontanum.  The  latter  of  these  is 
the  one  determined  by  Willdenow  ;  but  De  Candolle  is  of  opinion 
that  it  is  a  variety  of  Jl.  Paniculatum,  to  which  he  has  given  the 
name  Storkianum,  to  distinguish  it  as  the  species  employed  by 
Stork.  Besides  these,  however,  the  *ft.  Cammarum  and  «/#.  Jin- 
thora  have  found  a  place  in  several  continental  Pharmacopoeias. 

Each  of  our  Colleges  has  given  a  formula  for  the  preparation  of 
an  inspissated  juice  from  the  fresh  leaves  of  the  monkshood  ;  but 
in  addition  to  this,  the  powder  of  the  leaves,  the  wine  and  an  alco- 
holic and  two  ethereal  tinctures,  are  made  use  of  on  the  Continent  : 
all  of  these  are  employed  internally,  but  are  very  inconstant  in  their 
operation,  as  might  easily  have  been  anticipated  from  their  manner 
of  preparation  ;  and  this  circumstance  shall  be  presently  noticed. 
Very  recently,  M.  Lombard,  of  Geneva,  has  recommended  the  use 
of  an  alcoholic  extract  of  Aconite  in  the  treatment  of  acute  rheuma- 
tism, and  has  given  a  process  for  obtaining  it.  This,  though  a  much 
less  objectionable  one  than  any  of  those  above-mentioned,  gives  a 
product  that  is  still  inconstant  in  its  effects  ;  for  he  states  that  he  has 
given  with  success  from  half  a  grain  three  times  a-day,to  a  drachm  and 
a  half  in  the  twenty-four  hours.t  It  appears  that  there  are  several 
causes  why  the  preparations  of  Aconite  at  present  in  use  are  liable  to 
inconstancy  ;  they  are  all  prepared  either  from  the  fresh  plant  or  from 
the  expressed  juice  :  in  the  first  instance  they  must  vary  in  power, 
according  to  the  state  of  the  plant,  and  the  time  when  it  is  gathered  ; 
and  the  extracts  made  by  evaporating  the  expressed  juice  must  also 
vary,  as  in  the  very  act  of  expression  a  change  in  the  activity  of 
the  product  appears  to  take  place,  and  a  still  further  alteration  must 
ensue  during  the  process  of  evaporation.  I  have  tried  several  dif- 
ferent extracts  made  in  this  way,  and  have  found  them  almost  inert. 
The  process  employed  by  M.  Lombard  consists  in  carefully  evapo- 
rating the  expressed  juice  of  the  plant,  and  treating  the  extract  with 
alcohol  ;  then  filtering  and  evaporating  the  tincture  with  a  very 
gentle  heat.  In  this  way,  the  active  matter  contained  in  the  inspis- 

"*  Stork,  Spicileginm  Observationum  de  Aconito,  1788. 
f  Gazette  Medicate,  Juin,  1834. 


PROCESSES  FOR  PREPARING  ACONITINE.  55 

sated  juice  may  be  procured  in  a  more  concentrated  form,  but  still 
the  process  is  liable  to  some  of  the  objections  already  stated. 

Another  objection  to  these  preparations  is,  that  they  are  all 
obtained  from  the  least  active  part  of  the  plant,  for  the  root  certainly 
contains  a  much  greater  proportion  of  the  peculiar  properties  of  the 
Aconite  than  any  other  part,  and  is  consequently  that  which  should 
be  used.  From  these  considerations,  and  from  the  difficulty  of  pro- 
curing the  active  principle,  I  was  led  to  employ  a  tincture  and  al- 
coholic extract,  prepared  from  the  powder  of  the  root  carefully  dried. 
The  tincture  is  made  by  digesting  one  part  by  weight  of  the  powder, 
in  six  parts  by  measure  of  strong  alcohol,  for  seven  days,  and  filtering 
through  paper;  and  the  dose  for  an  adult  ought  not  to  be  more  than 
eight  or  ten  drops  three  times  a-day  to  commence  with,  but  it  may  be 
augmented  to  twenty  ;  beyond  which,  however,  few  patients  will 
bear  it  to  be  carried.  With  regard  to  the  extract,  I  have  never 
exhibited  it  internally,  but  have  employed  it  with  great  benefit  in 
the  manner  I  shall  immediately  mention. 

When  Aconite  is  administered  internally,  in  any  form,  and  in  a 
small  dose,  it  acts  as  a  diuretic  and  diaphoretic,  and  accelerates  the 
pulse  :  if  it  be  pushed  still  farther,  it  begins  to  affect  the  nervous 
system,  and  occasions  headache,  nausea,  weakness  of  the  joints  and 
muscles,  slight  confusion  of  intellect,  and  a  remarkable  sensation  of 
tingling  in  various  parts  of  the  body,  particularly  in  the  head,  face, 
and  extremities.  This  latter  circumstance  was  remarked  by  Dr. 
Duncan,  jun.,  as  always  accompanying  the  relief  afforded  by  the 
internal  exhibition  of  extract  of  Aconite  in  cases  of  Sciatica.*  If 
the  dose  be  still  augmented,  aberration  of  mind,  dimness  of  vision, 
and  convulsive  movements,  come  on.  A  few  cases  are  on  record, 
where  such  symptoms  have  shown  themselves  when  the  Aconite 
had  been  swallowed  accidentally  ;  and  they  have,  in  some  of  these, 
been  followed  by  fainting,  vomiting,  stupor,  and  death. 

The  diseases  in  which  Aconite  has  been  administered,  are  chiefly 
those  already  enumerated  ;  and  I  have  also  found  much  benefit  from 
its  employment  in  tic-douloureux,  and  other  painful  nervous  affec- 
tions ;  but  from  all  that  is  unknown  of  its  internal  use,  it  does  not 
appear  that  the  benefit  to  be 'derived  from  this  method  of  exhibition 
is  at  all  to  be  compared  with  that  which  arises  from  its  administra- 
tion by  the  Endermic  Method,  either  as  regards  the  amount  of  effect 
produced,  or  the  perfect  safety  with  which,  in  this  latter  mode,  it 
may  be  used. 


Processes  for  preparing  Jlconitine. 

THERE  are  three  forms  in  which  the  Aconite  may  be  employed 
externally,  namely, — the  active  principle  Aconitine  ;  impure  Aco- 
nitine,  as  contained  in  the  ammoniated  extract ;  and,  thirdly,  in  the 

V 

*  Edin,  New  Dispensatory,  1830. 


56  TURNBULL  ON  RANUNCULACE,E. 

form  of  tincture,  or  solution  of  the  active  principle  in  alcohol  ;  and 
of  these  it  is  now  proposed  to  give  a  short  account. 

M.  Peschier,  of  Geneva,  appears  to  have  been  the  first  experi- 
menter who  detected  the  presence  of  Aconitine,  during  a  chemical 
examination  of  the  JLconitum  Napellus  and  *tf.  Paniculatum  : 
he  describes  it  as  a  peculiar  alkaline  substance,  capable  of  forming 
crystallizable  salts  with  acids.*  It  appears  again  to  have  been  detected 
by  M.  Brandes,  in  the  «/?.  Neomontanum ;  but  no  particulars 
regarding  it  are  mentioned.  In  1825,  M.  Palias  described  the 
Aconitine  as  an  alkaline  substance,  which  he  had  obtained  in  scales 
of  a  yellowish  colour.! 

In  the  year  1832,  M.  Geiger,  from  the  result  of  his  physiological 
experiments  with  different  Aconites,  came  to  the  conclusion,  that 
the  acrid  Aconites  contained  a  narcotic  substance  different  from 
their  acrid  principle  ;  and  this  opinion  led  M.  Hesse  to  analyse  the 
Jlconitum  Napellus ;  and  from  this  he  obtained  a  peculiar  body, 
to  which  he  has  given  the  name  Aconitina.  The  process  for  ob- 
taining it  consists  in  precipitating  a  decoction  of  the  dried  leaves 
by  hydrated  magnesia,  washing  the  precipitate  with  water,  drying 
it,  and  then  treating  it  with  boiling  alcohol,  which  dissolves  the 
Aconiiine  and  deposits  it  on  cooling.J 

It  is  described  as  being  incrystallizable,  white  and  granular,  or 
in  a  colourless  mass,  transparent,  and  having  the  lustre  of  glass.  It 
is  alkaline,  inodorous,  and  has  a  bitter  acrid  taste.  This  acridity, 
however,  does  not  belong  to  the  Aconitine,  but  disappears  if  the 
base  be  several  times  combined  with  acids,  and  the  salt  formed  de- 
composed. When  deprived  of  this  acrid  principle,  it  is  poisonous 
in  the  highest  degree,  a  twelfth  part  of  a  grain  being  sufficient  to 
destroy  a  little  bird  with  the  rapidity  of  lightning.  Aconitine  is 
very  fusible:  it  is  little  soluble  in  water,  but  very  much  so  in 
alcohol  and  ether.  Its  solutions  are  alkaline,  and  it  neutralizes 
acids;  but  its  salts  are  not  capable  of  being  crystallized.  Such  is 
the  account  of  the  substance  obtained  by  MM.  Geiger  and  Hesse ; 
but  the  elementary  analysis  has  not  yet  been  accomplished. 

I  have  made  several  attempts  to  obtain  Aconitine  from  the 
Parisian  chemists,  for  the  purpose  of  employing  it  in  medicine,  but 
have  never  hitherto  succeeded.  It  is  now,  however,  prepared  in 
town,  and  may  be  had  in  sufficient  quantity  for  present  use,  by 
those  practitioners  who  may  wish  to  make  trial  of  its  properties. § 
Either  of  the  following  processes  will  yield  it :  the  first  is  the  easier 
to  manipulate,  but  the  second  yields  a  much  purer  result,  and  is  upon 
the  whole  to  be  preferred. 

A  quantity  of  the  fresh  root  of  the  Aconitum  Napellus  must  be 
procured,  and  care  should  be  taken  that  it  be  sound,  and  that  the 

*TrommsdorffNeues  Journal  der  Pharmacie,  vol.  84. 

t  Journal  de  Chimie  Medicale,  torn.  1 — 193. 

^p  Journal  de  Chimie  Medioale,  Aout,  1834. 

$  Aconitine  is  at  present  prepared  by  Mr.  Morson,  chemist,  Southampton  Row. 


PROCESS  FOR  PREPARING  ACONITINE.  57 

root  be  that  of  monkshood ;  for  sometimes  other  roots  are  sold  for 
it.  Let  it  be  carefully  and  cautiously  dried,  and  then  reduced  to 
powder;  this  latter  operation  is  not  unattended  by  danger,  especially 
if  a  part  of  the  fine  dust  which  rises  from  it  be  inhaled.  One  part 
by  weight  of  the  powder,  and  two  parts  by  measure  of  strong 
alcohol,  are  to  be  digested  together  in  a  gentle  heat  for  seven  days, 
and  the  tincture,  while  warm,  is  to  be  filtered.  It  is  then  to  be 
reduced  to  the  consistence  of  an  extract,  by  careful  evaporation,  at 
a  low  and  well-regulated  temperature ;  the  object  of  this  is  to  prevent 
the  destruction  or  expulsion  of  the  active  principle,  which  would 
very  probably  ensue,  if  the  temperature  employed  were  higher  than 
barely  sufficient  to  carry  off  the  alcohol.  To  the  extract  thus  pre- 
pared, liquid  ammonia  is  to  be  added,  drop  by  drop,  and  mixed 
well  with  it,  to  precipitate  the  alcaloid  ;  and  in  this  part  of  the  process 
care  must  be  taken  that  too  much  be  not  added,  as  in  some  instances 
the  product  appears  to  have  been  decomposed  by  inattention  to  this 
circumstance.  It  is  difficult  to  give  a  precise  rule  as  to  the  quantity  ; 
but  enough  will  have  been  added,  if  the  extract  give  out  the  odour 
of  ammonia,  when  stirred. 

The  mass  now  consists  of  impure  Aconitine,  mixed  up  with  a 
quantity  of  extractive  and  other  matters,  soluble  in  water ;  and  it 
may  be  taken  up  either  with  boiling  alcohol,  or  sulphuric  ether;  or 
the  soluble  matter  may  be  removed,  by  repeated  washings  with 
small  quantities  of  cold  water,  which  will  leave  the  Aconitine.  This 
latter  process  is  the  one  we  have  generally  employed,, and  is  per- 
formed by  pouring  a  little  water  on  the  extract,  and  mixing  them 
carefully  together,  then  allowing  the  unclissolved  part  to  subside, 
pouring  off  the  fluid,  and  repeating  the  operation,  as  long  as  any 
soluble  matter  is  taken  up,  a  quantity  of  light  brown  or  grey  powder 
is  left,  which  may  be  purified  by  subsequent  solution  in  alcohol. 
This  powder  contains  the  active  properties  of  the  Aconite,  in  a  high 
degree  of  concentration,  A  grain  of  it  was  dissolved  in  a  drachm 
of  alcohol ;  and  twenty  drops  of  the  solution  put  into  the  mouth  of  a 
guinea-pig  occasioned  death  in  a  few  minutes.  Other  experiments 
have  been  performed,  all  of  which  prove  the  extreme  energy  of  the 
substance. 

The  second  process  consists  in  dissolving  the  alcoholic  extract, 
prepared  as  before,  without  the  addition  of  the  ammonia,  in  as  much 
cold  water  as  will  take  it  up,  and  carefully  decanting  the  solution 
from  the  insoluble  part,  and  then  filtering  it.  To  the  filtered  solu- 
tion liquid  ammonia  is  to  be  added,  drop  by  drop,  as  long  as  it 
occasions  any  precipitation.  When  the  precipitate  has  subsided,  the 
supernatant  fluid  should  be  carefully  poured  away,  or  drawn  off  by 
means  of  a  syphon ;  and  after  the  precipitate  has  been  deprived  of 
as  much  of  the  fluid  as  possible,  it  should  be  purified  by  a  sufficient 
number  of  washings  with  small  quantities  of  cold  water,  or,  what  is 
better,  it  may  be  dissolved  in  as  much  alcohol  as  will  take  it  up, 
and  the  solution  thrown  into  cold  water;  and  the  precipitate  thus 

JANUARY,  1838. — F  6 


58  TURNBULL  ON  RANUNCULACE^E. 

formed   is  to  be  carefully   dried.     The  product  obtained  by  tbis 
process  is  white. 

External  Application  of  Aconitine. 

IT  has  already  been  stated,  that  if  a  grain  or  two  of  Veratria  or 
Delphinia  be  mixed  up  with  a  little  lard,  or  dissolved  in  a  drachm 
of  alcohol,  and  a  small  quantity  be  rubbed  upon  the  skin  of  the 
forehead  or  other  tender  part,  a  sensation  of  heat  and  tingling  will 
be  experienced,  after  the  friction  has  been  continued  for  a  minute  or 
two.  If  the  same  procedure  be  followed  with  the  Aconitine,  a 
similar  result  will  be  obtained.  The  sensations  produced  by  the 
three  substances  differ,  however,  in  a  few  particulars.  When  Vera- 
tria is  employed,  it  produces  a  strong  sensation  of  tingling  or  rather 
a  sharp  feeling,  similar  to  that  produced  by  receiving  a  succession 
of  electric  sparks  on  an  uncovered  part  of  the  body  ;  whilst  the 
Delphinia  gives  rise  to  a  sensation  of  burning,  not  unlike  that  which 
manifests  itself  a  short  time  after  the  application  of  a  blister,  but  not 
to  an  unpleasant  degree. 

The  Aconitine  is  possessed  of  an  action  similar,  in  some  respects 
at  least,  to  that  of  Uelphinia.  When  a  small  quantity  of  it,  either 
made  into  an  ointment,  or  dissolved  in  alcohol,  is  rubbed  for  a 
minute  or  two  upon  the  skin,  a  sensation  of  heat  and  prickling  is 
experienced  ;  to  this,  succeeds  a  feeling  of  numbness  and  constric- 
tion in  the  part,  as  if  a  heavy  weight  were  laid  upon  it,  or  as  if  the 
skin  were  drawn  together,  by  the  powerful  and  involuntary  contrac- 
tion of  the  muscles  beneath.  This  effect  lasts  from  two  or  three, 
to  twelve  or  more  hours,  according  to  the  quantity  rubbed  in.  So 
small  a  portion  as  the  one-hundreth  part  of  a  grain  has  produced  a 
sensation  that  has  continued  a  whole  day;  but  the  alcoloid,  in  this 
instance,  was  in  a  high  degree  of  purity. 

The  action  of  the  Aconitine  upon  the  cutaneous  vessels,  appears 
to  be  less  than  that  of  either  Veratria  or  Delphinia  ;  for  in  no  case 
hitherto  observed,  has  it  produced  a  greater  degree  of  vascular  ex- 
citement than  might  easily  be  accounted  for  by  the  friction  itself; 
and  in  one  instance  where  the  Veratria  ointment  did  occasion  irrita- 
tion, the  Aconitine  has  been  employed  without  giving  rise  to  any. 

The  diseases  in  which  I  have  .chiefly  employed  the  Aconitine 
externally,  are  Tic-Douloureux  and  Neuralgic  affections  generally, 
and  in  gouty  and  rheumatic  cases ;  and  its  success  has  fully  answered 
the  anticipations  that  had  been  formed  of  its  utility.  It  may  be 
employed  in  the  form  of  solution  in  alcohol,  in  the  proportion  of 
one  or  more  grains  to  the  drachm,  and  in  ointment,  made  according 
to  the  following  prescription : — 

R.  Aconitinae,  gr.  ii. 

Alcohol,  gtt.  vi.  tere  optime 
et  adde,  Axung,  g  i.  ut  fiat  unguent. 

The  object  of  adding  the  alcohol,  is  to  prevent  the  Aconitine  from 


EXTERNAL  APPLICATION  OF  ACONITE.  59 

forming  a  thick  compound   with  part  of  the  lard,  which  renders  it 
difficult  to  make  a  proper  ointment. 

The  proportion  of  the  alcaloid  in  this  prescription  will,  in  general, 
be  sufficient  to  begin  with,  but  it  may  be  augmented  to  four  or  five 
grains  to  the  drachm,  if  necessary  :  and  in  one  case  of  Tic-Douloureux 
of  unusual  severity,  as  much  as  eight  grains  to  the  drachm  were 
prescribed  with  the  most  marked  benefit.  The  best  manner  of 
applying  the  ointment,  is  simply  to  rub  a  small  part  of  it  over  the 
whole  seat  of  the  affection,  till  the  pain  be  either  for  the  time  re- 
moved, or  until  the  full  effect  upon  the  cutaneous  nerves  above 
described  be  brought  about ;  and  the  friction  should  be  repeated 
three  or  four  times,  or  more  frequently  in  the  day,  according  to  the 
effect  produced  upon  the  disease.  The  proportion  of  the  Aconitine 
ought  to  be  increased  at  every  second  or  third  friction  ;  and  the 
same  rule  elsewhere  laid  down,  in  regard  to  the  action  of  Veratria 
and  Delphinia,  also  holds  good  in  the  present  instance, — namely, 
that  unless  the  friction  occasion  a  full  development  of  the  peculiar 
impressions  caused  by  the  Aconitine  when  rubbed  on  the  skin,  no 
benefit  whatever  is  to  be  looked  for  from  its  employment.  It  is 
almost  needless  to  remark,  that  an  application  of  such  activity  should 
not  be  resorted  to,  if  there  be  the  slightest  abrasion  of  the  surface 
of  the  skin,  and  that  it  should  be  carefully  kept  from  coming  in 
contact  with  any  of  the  mucous  membranes. 

External  Application  of  the  <ftmmoniated  Extract  of*/lconite,fyc. 

THE  next  preparation  that  requires  notice,  is  the  ammoniated 
extract  of  Aconite;  this  is  probably  the  best  appellation  for  the  sub- 
stance, although  it  be  in  reality  a  mixture  of  all  the  active  principles, 
along  with  extractive  and  other  matters.  It  is  made  by  evaporating 
very  carefully,  and  at  a  low  temperature,  the  tincture  of  the  dried 
root  of  the  plant,  prepared  as  already  directed  in  the  process  for 
obtaining  the  Aconitine,  to  the  consistence  of  an  extract.  To  every 
drachm  of  this,eight  or  ten  drops  of  liquor  ammonise  should  be  added  ; 
and  after  the  mixture  has  stood  a  short  time  in  a  very  gentle  heat, 
to  drive  off  the  excess  of  ammonia,  it  is  to  be  used  in  the  form  of  oint- 
ment, according  to  the  following  prescription  : — 

R.  Extract.  Acoriit.  Amnion.  5  i* 

Axiing,  ^  iii«     M.  ut  fiat  unguent. 

This,  from  its  dark  colour,  may  be  a  less  agreeable  application 
than  the  Aconitine  ointment :  but  it  appears  to  me,  to  be  at  least  as 
efficacious,  and  it  has  the  advantage  of  being  easily  and  cheaply 
prepared  :  and  on  these  accounts  it  is  better  suited  for  hospital 
practice.  The  proportion  of  the  extract  may  be  increased  two  or 
three-fold,  according  to  circumstances. 

When  this  ointment  is  rubbed  upon  the  skin,  it  occasions  sensa- 
tions in  the  part,  similar  to  those  which  are  produced  by  the  Aco- 
nitine ointment ;  th&y  are,  however,  rather  more  pungent  in  their 


60  TURNBULL  ON  RANUNCULACE^. 

character  ;  and  this  probably  arises  from  the  extract  containing 
what  is  called  the  acrid  principle  of  the  plant,  as  well  as  the  alcaloid 
itself ;  and  it  is  absolutely  necessary  that  with  this  preparation  also, 
these  sensations  should  be  induced,  in  order  to  its  having  a  full 
effect  on  the  disease  for  which  it  is  applied. 

In  less  severe  cases,  the  simple  saturated  tincture  of  the  dried 
root,  with  or  without  the  addition  of  a  little  ammonia,  may  be  used  ; 
it  has  similar  properties,  but  in  a  much  smaller  degree  of  develop- 
ment, with  the  two  preparations  above  mentioned,  and  the  same 
instruction  as  to  its  use  ought  to  be  attended  to. 


Severe  Case  of  Neuralgia  in  the  Finger,  treated  by  Prepara- 
tions of  Aconite. 

THE  following  case  has  been  selected  as  affording  the  most  con- 
clusive evidence  possible  of  the  efficacy  of  preparations  of  Aconite 
in  removing  Neuralgia.  It  is  one  of  the  most  severe  and  obstinate 
on  record  ;  and  during  a  period  of  above  two  years,  had  resisted 
every  means  that  could  be  devised  for  its  removal.  The  previous 
history  and  treatment  are  taken  from  a  very  able  lecture  on  Neu- 
ralgia by  Dr.  Elliotson,  which  was  published  in  the  Lancet  of  De- 
cember Sth,  1832. 

Samuel  Best,  residing  No.  7,  Somers  Street,  Liquorpond  Street. 

"  This  man  was  a  journeyman  printer,  aged  32,  and  had  been  ill 
two  years.  He  first  of  all  had  pain  of  the  legs,  arms,  and  wrists, 
and  when  he  came  in,  the  pain  was  confined  to  the  middle-finger 
of  the  left-hand,  on  each  side,  along  the  course  of  the  nerve.  The 
other  fingers  of  the  same  hand  were  benumbed — were  without  any 
great  degree  of  feeling,  but  the  thumb  was  unaffected.  Originally 
he  had  had  pain  on  the  right  side  of  the  face — that  is  on  the  oppo- 
8ite  side  of  the  body,  and  the  pain  then  commenced  in  the  sub- 
maxillary  nerve,  and  extended  upwards,  so  as  partly  to  affect  the 
second  branch  of  the  fifth  pair,  as  well  as  the  third.  It  is  there- 
fore to  be  recollected,  that  he  had  had  Neuralgia  in  another  part  of 
the  body.  All  this,  however,  had  ceased  a  month  before  admission, 
at  which  time  he  had  only  pain  on  each  side  of  the  middle-finger, 
and  after  that  had  existed  some  time,  the  other  fingers  had  become 
benumbed. 

"The  pain  was  of  a  very  agonising  character  ;  a  plunging,  stab- 
bing pain,  as  though  you  were  running  a  penknife  along  the  finger. 
Patients  usually  describe  the  pain  in  neuralgia  as  stabbing  and 
plunging.  The  least  touch  gave  him  violent  pain,  like  an  electric 
shock.  As  the  least  touch  produced  such  violent  pain,  he  could 
not  bear  his  nails  to  be  cut,  and  the  consequence  was,  that  the  nails 
of  that  hand  had  grown  to  a  great  length.  He  could  not  sustain 
the  motion  of  the  hand  which  the  cutting  of  the  nails  necessarily 
produced,  and  the  agony  of  the  pain  was  such,  that  he  bit  the 
nails  of  the  fingers  of  the  other  hand,  so  that  the  nails  on 
the  fingers  of  it  were  eaten  down  by  him  in  his  agony,as  far  as  they 


NEURALGIA  IN  THE  FINGER.  61 

could  be.  The  appearance  was  certainly  very  remarkable  ;  for  on 
one  hand  the  nails  were,  as  I  have  just  said,  as  short  as  they  could 
be  ;  and  on  the  other  hand,  though  they  were  not  so  long  as  they 
might  be,  yet  they  were  of  very  great  length.  I  believe  whenever 
he  had  a  very  violent  attack  of  pain,  the  nails  of  the  affected  hand 
became  discoloured,  and  remained  so  for  some  time. 

"  I  could  detect  no  cause  for  this  at  all.  I  could  connect  it  with 
no  obvious  morbid  state,  and  therefore,  what  produced  the  pain  I 
could  not  tell.  I  could  only  say  there  was  a  pain,  and  that  the  pain 
was  clearly  situated  in  the  nerves — following  the  course  of  nerves, 
affecting  other  parts  also  exactly  in  the  situation  of  branches  of 
known  nerves,  and  having  the  usual  character  of  pain  of  the  nerves, 
or  at  least,  what  it  very  frequently  is,  stabbing  and  plunging. 
There  was  no  heat  or  inflammation  of  the  fingers  ;  nothing  what- 
ever to  be  seen  ;  but  yet  there  was  agonising  pain,  and  the  slightest 
touch  aggravated  the  pain  when  present,  or  brought  it  on  at  a  mo- 
ment when  he  scarcely  felt  any. 

"  Treatment. — One  of  the  best  remedies  in  this  disease,  but  by 
no  means  a  specific,  and  by  no  means  so  successful  I  think  as  in 
some  other  nervous  complaints,  is  carbonate  of  iron.  Its  efficacy 
in  this  disease,  so  far  as  I  know,  was  first  pointed  out  by  Mr.  Hutch- 
inson,  a  surgeon  in  the  country,  who,  I  believe,  is  now  dead.  *  * 

"This  man's  complaint  having  lasted  two  years,  and  carbonate 
of  iron  being  an  innocent  remedy,  provided  you  keep  the  bowels 
regularly  open,  he  took  half  an  ounce  three  times  a  day  ;  and  when 
he  had  taken  that  for  five  days  without  any  benefit  whatever,  he 
took  the  same  quantity  every  four  hours. 

"Now  this  did  him  a  certain  degree  of  good.  He  was  better. 
Still  he  had  pain  sufficient  to  keep  him  awake  at  night  ;  and  I  gave 
him,  in  addition,  a  quarter  of  a  grain  of  muriate  of  morphia.  The 
benefit  was  but  temporary  ;  and  I  applied  to  the  finger  a  solution 
of  the  eyanuret  of  potassium,  which  has  been  so  much  praised  by 
the  French.  But  it  did  not  relieve  him  materially,  and  the  solution 
was  then  made  stronger  than  the  French  have  recommended  it.  It 
was  carried  as  far  as  twenty-four  grains  to  an  ounce  of  water.  After 
a  time  it  was  suggested,  that  it  was  merely  the  cold  which  did  him 
good,  and  I  applied  ether,  to  see  if  that  would  relieve  him,  and  it 
did  so,  much  more  than  the  solution  of  eyanuret  of  potassium  had 
done.  Still,  however,  he  was  very  little  better.  The  amend- 
ment which  he  at  first  experienced  on  taking  the  iron  ceased,  and  I 
was  obliged  to  increase  the  dose  of  medicine,  and  likewise  the  mu- 
riate of  morphia,  for  he  obtained  no  sleep.  He  took  a  whole  grain 
of  the  latter  every  night.  The  iron  was  then  increased  to  the 
quantity  of  an  ounce,  and  it  was  given  every  four  hours.  His 
health  improved  under  it,  and  from  being  pale  and  thin,  he  lost  his 
great  paleness,  and  gained  flesh,  and  thought  himself  quite  another 
man,  so  far  as  his  general  health  was  concerned.  The  quantity  of 
eyanuret  of  potassium  was  increased  now,  to  a  drachm  in  an  ounce 
of  water  but  it  afforded  no  relief.  He  still  found  more  benefit 


62  TURNBULL  ON  RANUNCULACE^E. 

from  ether.  One  could  not  expect  a  man  to  continue  swallowing 
more  than  an  ounce  of  iron  every  four  hours.  He  would  have  taken 
it  in  any  quantity,  but  it  was  necessary  to  consider  his  stomach,  not- 
withstanding his  good  will  to  take  the  medicine.  I  therefore  gave 
him  another  form  of  iron  also,  the  sulphate.  I  do  not  know  that 
the  carbonate  is  superior  to  the  sulphate  in  this  disease,  or  in  cho- 
rea, and  the  latter  may  frequently  be  taken  the  most  easily.  He 
began  with  five  grains,  in  conjunction  with  the  carbonate  of  iron, 
and  took  both  every  three  hours.  His  agony  was  still  extreme,  and 
the  sulphate  was,  therefore,  increased  to  ten  grains,  and  afterwards 
to  fifteen.  He  received  some  degree  of  benefit,  but  it  was  only 
temporary. 

"  I  thought  now  that  the  iron  had  had  a  very  fair  trial,  and  it  was 
only  relinquished  on  the  26th  of  July,  he  having  begun  to  <ake  it 
on  the  8th  of  March,  so  that  he  had  continued  it  for  three  months. 
This  was  a  very  fair  trial,  both  with  respect  to  the  quantity  of  the 
dose,  and  the  long  continuance  of  its  exhibition.  *  *  * 

"  I  then  relinquished  the  iron  altogether,  and  endeavoured  to 
apply  strychnine  to  the  finger.  We  attempted  to  blister  the  finger, 
and  then  sprinkled  half  a  grain  of  I  he  strychnine  upon  it.  It  was, 
however,  with  very  great  difficulty  that  we  produced  vesication  ; 
very  imperfect  vesication  was  effected,  and  therefore  it  was  not 
very  well  managed.  I  still  determined  on  trying  whether  the 
strychnine  would  do  him  good  or  not,  and  I  therefore  exhibited  the 
twelfth  of  a  [grain  internally.  As  strychnine  is  so  powerful  an 
agent,  I  never  like  to  begin  with  a  larger  quantity  than  that.  It 
was  then  increased  gradually  to  the  eleventh,  tenth,  ninth,  eighth, 
and  so  on,  of  a  grain.  Still  he  was  no  better,  and  I  was  obliged  to 
increase  the  muriate  of  morphia  to  two  grains  every  night,  one  grain 
being  said  to  be  equal  to  four  grains  of  opium.  The  man  told  me, 
with  tears  in  his  eyes,  that  the  agony  was  such  that  he  never  slept. 

"The  strychnine  was  increased  now  to  half  a  grain  three  times 
a-day,  and  I  had  the  finger  smeared  with  croton  oil.  He  could  not 
bear  to  have  it  rubbed  in,  and  therefore  it  was  gently  smeared  on 
the  part,  but  produced  no  great  irritation.  His  health  now  began  to 
decline.  He  was  taking  on  the  7th  of  August  three-fifths  of  a  grain 
of  strychnine  three  times  a-day,  and  two  grains  and  a  half  of  mu- 
riate of  morphia,  but  he  began  to  take  the  iron  again.  I  gave  it 
him  without  any  hopes  of  its  producing  benefit,  but  for  the  purpose 
of  improving  his  general  health.  He  began  with  half  an  ounce 
three  times  a-day,  which  was  increased  to  an  ounce,  and  then  to 
four  times  a-day.  His  health  soon  improved  again,  but  the  pain 
continued  unabated,  and  the  muriate  of  morphia  was  increased  to 
three  grains  twice  a-day.  His  pain  was  such,  that  I  was  obliged  to 
give  him  an  opiate  in  the  day  time  as  well  as  at  night.  The  strych- 
nine was  not  increased  beyond  three-fifths  of  a  grain  three  times 
a-day,  and  as  it  did  him  no  good,  merely  produced  some  twitching 
of  the  limbs,  it  was  relinquished  on  the  21st  of  August,  never 
having  been  of  the  slightest  service.  Arsenic  has  been  known  to 


NEURALGIA  IN  THE  FINGER.  53 

be  serviceable  in  some  cases  combined  with  an  alkali  as  in  the 
liquor  arsenicalis.  He  commenced  with  this  on  the  21st  of  August, 
and  began  with  small  doses  three  minims  three  times  a-day,  not 
taking  it  on  an  empty  stomach.  This  was  increased  gradually  to 
nine  minims,  but  without  any  effect  on  the  disease,  though  it 
began  to  make  him  sick.  Nine  minims  I  consider  a  very  full  dose. 
It,  however,  disturbed  his  stomach,  and  to  prevent  the  sickness  he 
took  two  minims  of  hydrocyanic  acid  three  times  a-day,  half  an 
hour  before  the  arsenic.  This  did  not  lessen  the  sickness,  and  I 
therefore  was  obliged  to  increase  it  to  three  minims,  and  went  gra- 
dually on  till  I  arrived  at  a  dose  of  nine  minims  three  times  a-day. 
This  entirely  prevented  the  sickness  arising  from  the  arsenic.  Hy- 
drocyanic acid  has  the  very  valuable  property  of  stopping  vomiting, 
provided  this  does  not  depend  on  inflammation.  Knowing  the 
power  that  it  has  of  tranquillizing  the  stomach  generally,  though  it 
does  not  invariably  produce  relief  in  gastrodinia,  I  thought  it  would 
stop  vomiting.  I  never  heard  that  it  had  been  used  in  such  cases, 
but  I  thought  it  must  do  good.  After  employing  it  for  two  or 
three  years,  I  thought  it  might  prevent  medicines  from  causing 
further  vomiting.  1  tried  it,  and  I  found  that  it  had  that  power  in 
a  very  marked  degree.  Finding  in  this  case  that  two  minims  had 
no  effect,  I  gradually  increased  it,  as  I  have  before  mentioned,  to 
nine  minims,  and  it  then  entirely  stopped  the  sickness  caused  by 
the  arsenic. 

"All  this  time  the  arsenic  did  no  good  ;  he  bore  it  very  well,  but 
it  was  of  no  service  to  him,  and  I  therefore  gradually  increased  it 
to  the  largest  dose  that  I  ever  gave — viz.  twenty  minims  three 
times_a-day.  He  now  began  to  look  thin  again — did  not  look  so 
well  as  before.  I  could  not,  however,  tell  whether  it  was  the  result 
of  the  arsenic.  It  might  merely  have  arisen  from  his  extreme  suf- 
fering, but  still  it  was  right  that  I  should  discontinue  the  medicine, 
and  I  did  so  without  his  having  derived  the  slightest  benefit  from  it 
during  the  whole  period  of  its  exhibition.  As  it  was  necessary  to 
procure  sleep,  the  muriate  of  morphia  was  gradually  increased  up  to 
six,  and  at  last  to  eight  grains  twice  a-day.  His  agony  was  such, 
that  the  begged  to  have  the  opiate,  and  he  also  begged  to  have  it 
increased,  otherwise  he  said  he  could  scarcely  exist. 

"  He  was  taking,  therefore,  at  last,  eight  grains  of  muriate  of 
morphia,  twice  a-day,  which  gave  him  ease,  (I  got  him  to  omit  it 
once  or  twice,  but  he  suffered  so  much,  that  he  begged  to  have  it 
again),  and  twenty  minims  of  liquor  arsenicalis,  always  taking 
before  it  nine  minims  of  hydrocyanic  acid.  This  he  bore  perfectly 
well,  with  the  exception  that  he  looked  as  ill  as  he  did  when  he  first 
came  in,  not  worse,  but  just  as  he  did  before  I  gave  him  the  iron. 

"  He  now  wished  to  go  out  of  the  hospital  for  a  fortnight  for  a 
change,  and  he  was  supplied  with  a  quantity  of  muriate  of  morphia 
to  take  with  him  till  he  came  again. 

"  I  attempted,  during  the  time,  other  local  measures.  He  once 
rubbed  the  extract  of  stramonium  on  his  finger  frequently  every 


64  TURNBULL  ON  RANUNCULACE.E. 

day,  and  it  relieved  him  for  a  time.  He  rubbed  also  the  extract  of 
belladonna,  two  or  three  times  a-day,  and  this,  he  said,  certainly 
produced  relief  for  some  time  ;  but  I  am  sorry  to  say,  that  at  the 
very  last  he  was  nearly  as  bad  as  at  first.  He  himself  maintained  that 
he  was  a  great  deal  better  ;  he  did  not  allow  it,  but  maintained 
it.  I  was  afraid  that  he  was  not  improved,  but  he  assured  me  that 
he  was  better  after  he  took  the  iron  :  that  altogether  his  sufferings 
were  not  such  as  they  were  before  he  came  to  the  hospital  ;  but  still 
they  were  dreadful.  He  appeared  to  be  an  excellent  man,  a  man  of 
a  strong  mind,  but  in  his  agony  the  tears  were  seen  running  down 
his  cheeks. 

"  He  will  return,  but  I  have  no  idea  of  medicine  doing  him  any 
further  good.  We  have  given  him  the  most  powerful  remedies,  and 
these  have  been  used  in  the  most  powerful  manner,  although  with 
great  care,  but  he  is  not  materially  better,  and  therefore,  when  he 
comes  back  it  is  to  be  considered  whether  or  not  he  shall  have  his 
finger  amputated.  I  have  very  little  hope,  however,  in  the  opera- 
tion, and  for  this  reason — cases  have  occurred  in  which  the  opera- 
tion has  failed,  the  disease  having  reappeared  in  the  corresponding 
nerves  of  the  other  hand,  and  in  the  trunk  of  the  nerves  the  branches 
of  which  have  suffered  amputation.  Still  it  may  be  right  to  make 
the  trial.  I  have  little  hope  of  success,  however,  for  another  reason, 
because  he  has  had  the  affection  before  in  the  nerves  of  the  face." 

This  patient  came  under  treatment,  about  the  end  of  October,  1834, 
and  in  detailing  his  subsequent  progress,  I  shall  confine  myself  to  a 
weekly  report,  in  order  to  avoid  repetition.  The  history  which  he 
gave  of  his  case  was  substantially  the  same  as  that  quoted  above. 
He  stated,  that  since  December  1832,  he  had  been  suffering  in  an 
extreme  degree,  that  he  had  been  in  the  hospital  about  eighteen 
months  subsequent  to  that  date,  and  had  been  using  every  remedy 
that  was  likely  to  afford  relief,  but  in  vain.  He  stated,  that  the  only 
ease  he  had,  was  from  taking  large  doses  of  morphia,  to  the  extent 
of  from  ten  to  twenty  grains  a-day  ;  but  that  even  these  procured 
him  only  a  few  hours  of  broken  rest. 

The  pain  was  seated  in  the  fingers  and  wrist  of  the  left  hand,  but 
particularly  in  the  middle  finger,  through  which,  and  along  the  wrist, 
it  darted  like  a  stab  with  a  knife.  He  could  not  bear  the  slightest 
degree  of  motion  in  any  of  the  joints,  either  of  the  fingers  or  wrist, 
without  bringing  on  a  violent  paroxysm  of  pain,  and  for  the  same 
reason  he  could  not  suffer  the  middle  finger  to  be  touched.  His  nails 
were  long  and  curved.  The  ring  and  little  fingers  were  benumbed 
and  painful,  and  a  similar  feeling  extended  up  the  arm  as  far  as  the 
shoulder.  He  had  had  no  pain  in  his  face  for  three  months,  but  he 
stated  that  the  pain  in  the  hand,  at  times,  almost  deprived  him  of  his 
senses.  His  appearance  was  wretched,  and  indicated  the  sufferings 
he  endured. 

First  Week.  Under  these  circumstances,  he  was  ordered  to  rub 
the  saturated  Tincture  of  the  root  of  the  •flconitum  Napellus,  pre- 


NEURALGIA  IN  THE  FINGER.  $5 

pared  as  already  directed,  for  twenty  minutes,  along  the  back  of  the 
hand  and  fingers.  The  friction  at  first  gave  him  extreme  pain,  but 
towards  the  end  of  the  time  he  could  bear  it  better,  and  it  gave  rise 
to  a  sensation  of  heat  in  the  affected  finger,  which  was  attended  by  a 
marked  diminution  of  the  pain.  He  was  ordered  to  repeat  the  fric- 
tion for  ten  minutes,  twice  a  day,  and  to  take  six  drops  of  tincture 
of  Aconite,  prepared  for  internal  use,*  every  four  hours,  in  water. 
The  immediate  effect  of  this  treatment  was,  to  enable  the  patient  to 
do  without  his  daily  dose  of  twelve  grains  of  acetate  of  morphia, 
which  he  had  been  in  the  habit  of  taking  for  many  months  before. 
The  friction  excited  sensations  of  heat  and  numbness  in  the  hand, 
and  could  be  borne  with  greater  ease  at  each  successive  application, 
and  he  could  sleep  three  or  four  hours  at  a  time  without  interruption. 
The  dose  of  the  tincture  was  gradually  augmented  in  the  course  of 
this  week,  to  ten  drops  every  four  hours,  and  the  friction  was  ordered 
to  be  used  till  heat  and  tingling  were  produced,  whenever  the  pain 
came  on. 

The  pain  was  removed  every  time  the  tincture  was  applied,  and 
the  quantity  taken  internally  occasioned  tingling  and  numbness  in 
the  extremities,  and  acted  as  a  diuretic.  The  patient  slept  six  or 
seven  hours  at  a  time  :  he  had  intervals  of  perfect  freedom  from  pain, 
with  distinct  paroxysms,  varying  in  intensity  :  and  on  the  seventh 
day,  from  the  commencement  of  the  treatment,  he  was  so  far  reco- 
vered, that  he  could  bear  to  have  his  nails  cut,  which  had  not  been 
the  case  for  nine  months  previously. 

Second  Week.  During  the  next  seven  days  the  same  treatment 
was  continued.  He  took  the  tincture  internally,  in  nearly  the  same 
dose,  and  rubbed  it  on  the  affected  joints,  whenever  the  pain  came  on. 
Under  these  means,  the  accessions  of  pain  gradually  diminished  in 
intensity,  and  the  intervals  of  complete  relief  became  longer,  so 
that  at  the  end  of  this  week  he  had  little  pain  except  on  motion. 

Third  Week.  This  week  he  was  directed  to  continue  the  same 
treatment,  to  use  the  affected  joints  as  much  as  he  could  :  this,  how- 
ever, brought  on  attacks  of  pain,  but  these  were  at  once  removed  by 
frictions,  continued  until  tingling  was  produced. 

Fourth  Week.  On  the  first  day  of  this  week  he  was  directed  to. 
substitute  for  the  tincture  the  following  ointment: — 

R.     Aconitinse.  gr.  ii. 

Adipis.  3  i>  ut  flat  unguent. 

and  to  rub  with  it  whenever  he  had  pain. 

The  tingling  caused  by  this  ointment  was  very  considerable,  ami 
generally  lasted  three  or  four  hours  afterwards.  He  had  occasion  to 
use  it  three  times  a-day,  and  one  grain  of  Aconitine  was  added  to  the 
second  prescription,  as  the  first  began  to  lose  its  effect.  In  a  day 
or  two  he  discontinued  the  tincture  internally,  and  was  directed  ta 
use  the  ointment  of  the  ammoniated  extract  of  Aconite,  made  ae** 

*  Vide  page  55. 


66  TURNBULL  ON  RANUNCULACE^E. 

cording  to  the  formula  already  given,  in  order  to  try  the  comparative 
effect  of  this  application.  In  this  case  it  was  found  to  produce  a 
more  powerful  sensation  in  the  parts  than  the  Aconitine  itself,  and 
to  be  very  useful  in  removing  attacks  of  pain  when  they  came  on. 
He  used  nothing  except  the  remedies  mentioned  above,  and  at  the 
end  of  four  weeks  and  three  days  from  the  commencement  of  the 
treatment,  he  was  totally  free  of  pain,  and  has  continued  to  be  so 
ever  since.  He  can  use  his  hand  with  perfect  freedom,  but  complains 
of  its  not  being  so  strong  as  the  other,  probably  on  account  of  his 
having  been  obliged  to  keep  it  for  four  years  almost  in  the  same 
position. 

On  the  6th  of  January  last,  he  had  an  attack  of  pain  in  the  right 
cheek,  on  account  of  his  having  been  exposed  to  the  effects  of  cold, 
this  was,  however,  immediately  removed  by  the  Aconitine  ointment ; 
he  has  had  no  return  of  it,  and  is  at  present  in  excellent  health. 


ST.  THOMAS'S  HOSPITAL  REPORT. 

(From  the  London  Medical  and  Surgical  Journal  of  Saturday,  December  13, 1834.) 

"  M.  A.  Huntingford,  aet.  28,  admitted  into  St.  Thomas's  Hospital, 
under  the  care  of  Dr.  Roots,  April  3d,  1834.  She  then  stated 
that  she  had  been  subject  to  paroxysms  of  pain  in  the  loins,  thighs, 
and  legs,  for  more  than  two  years,  which  had  gradually  increased. 
She  had  been  in  the  hospital,  under  Dr.  Elliotson,  in  January  last, 
by  whom  she  was  at  first  freely  depleted  ;  after  which  the  disease 
assumed  an  intermittent  form,  and  she  then  took  large  doses  of  qui- 
nine, and  was  slightly  relieved  by  it,  but  left  the  hospital  before  she 
was  well,  and  soon  became  worse. 

"  At  the  time  of  her  second  admission,  her  general  health  was  not 
impaired.  She  was  subject  to  paroxysms  of  pain,  generally  two  every 
day,  in  the  loins,  hips,  thighs,  and  legs,  following  the  course  of  the 
sciatic  nerve.  The  pain  was  of  a  severe,  cutting  kind,  and  attended 
by  some  twitching  of  the  muscles.  There  was  a  tenderness  on  pres- 
sure of  the  lumbar  vertebrae,  and  along  the  whole  course  of  the  scia- 
tic nerve.  The  paroxysms  of  pain  came  on  and  ceased  suddenly, 
and  without  any  warning  :  they  did  not  observe  any  regular  intervals, 
and  were  of  variable  duration,  often  continuingfor  several  hours ;  and 
in  the  intervals  she  was  seldom  free  from  uneasiness.  Has  no  symp- 
toms of  hysteria  ;  menstruation  regular. 

**  Quinae  sulph.  gr.  v. 

Ferri  sub-carb.  J  ij.-—6  ta.  quaque  hora.  ,i-n 

Kinpl.  canth.  sacro. 

"  April  9th.     No  change. 

«*  Ferri.  carb.  5  iij-  extr.  stramonii.  gr.  ss.  6  tis  horis, 
"  On  the  I2th,the  paroxysms  were  of  rather  shorter  duration, 
but  returned  as  frequently,  and  were  quite  as  severe  as  ever.     The 


ST.  THOMAS'S  HOSPITAL  REPORT.  67 

quinine  was  increased  to  gr.  vij.  and  the  iron  to  5  iv.  in  each  dose. 
On  the  14th  she  had  no  pain,  and  only  a  little  on  the  evening  of 
the  16th.  Quinine  increased  to  gr.  x.  in  each  dose.  The  inter- 
mittent character  of  the  pain  continued  to  the  30th,  and  the  paroxysms 
had  gradually  become  less  severe  and  of  shorter  duration.  The 
stramonium  was  omitted  on  this  day,  as  the  sight  had  become  affect- 
ed by  it. 

"  May  3d.  The  improvement  had  continued,  and  the  quinine 
was  increased  to  gr.  xv.  From  the  9th  to  the  24th,  she  suffered 
from  head-ache*and  sickness  ;  but  the  medicine  was  continued,  and 
the  pain  abated.  On  the  24th,  the  iron  was  increased  to  5  vi.  ;  and 
on  the  28th,  gr.  £  of  muriate  of  morphia  was  ordered  with  each 
dose. 

"June  llth.  The  pain  still  better  and  intermitting  ;  but,  in  con- 
sequence of  continued  headache  and  sickness,  all  the  medicines  were 
omitted. 

"  ling,  veratri  O  i.  ad.  3«  i«  ?)  3  i-  ter.  die.  lumbis. 

"  On  the  14th,  the  pain  had  become  more  severe,  and  the  quinine, 
carbonate  of  iron,  and  muriate  of  morphia,  were  gradually  resumed, 
and  increased  up  to  August  23d  ;  at  which  time  she  was  taking 

"  Quince  sulph.  £)  i. 
Ferri  subcarb.  %  i. 
Morphise  muriat.  gr.  £,  6  tis  horis. 

"  These  medicines  were  omitted  for  four  days,  during  which  she 
took  some  creosote  ;  but  the  pains  returned  immediately  after  the 
medicine  was  changed,  and  continued  to  increase.  The  old  medi- 
cines were  resumed,  and  she  quickly  improved,  as  before.  She 
left  the  hospital  on  the  22d  of  September,  of  her  own  accord  ;  the 
pain  had  diminished  much  in  severity, — returned  much  less  fre- 
quently, and  not  at  any  regular  intervals.  The  pain  soon  increased, 
but  never  attained  its  original  severity.  She  was  again  admitted 
into  the  hospital,  under  Dr.  Roots,  Nov.  21st.  The  pain  was  of  the 
same  character,  and  in  the  same  situation  as  before  ;  commencing 
in  the  loins,  and  afterwards  affecting  the  gluteal  muscles,  and 
extending  down  the  back  part  of  [the  thighs  to  the  hams  and 
heels.  The  paroxysms  usually  came  on  about  7,  p.  m.,  and  con- 
tinued four  or  five  hours.  During  the  attack  the  muscles  were 
firm  and  contracted.  There  was  some  tenderness  of  the  gluteal 
muscles  at  all  times.  General  health,  good  ;  pulse,  seventy-five, — 
feeble.  On  the  25th,  the  following  ointment  was  ordered  : — 

"Aconitae,  gr.  ij. 

Ung.  cetacei.  3  *•  ft.  ung.  et  infricet  pars  sexta  part, 
dolent.  nocte  maneq. 

"  On  the  28th,  she  stated  that  after  each  application  of  the  oint- 
ment, the  parts  rubbed  became  hot,  and  smarted  ;  but  this  was 
quickly  followed  by  numbness.  After  the  third  application,  the 
pain  was  a  little  relieved  ;  and  after  the  fifth,  the  amendment  was 


68  TURNBULL  ON  RANUNCULACEJ3. 

very  remarkable.  The  paroxysms  were  much  diminished  in 
severity,  and  did  not  continue  more  than  one  or  two  hours.  The 
pain,  which  had  formerly  been  very  acute,  she  described  as  being 
much  less  severe,  and  called  it  a  "  burning  twitching."  The  parts 
were  less  tender  on  pressure,  and  she  could  sit  up  without  causing 
pain  in  the  gluteal  muscles,  which  she  could  not  do  three  days 
since. 

"  Infricet.  unguent  ter  die. 

"  Dec.  2d.  Two  days  since,  in  the  morning,  she  had  a  more 
violent  paroxysm  of  pain  than  she  has  had  since  her  admission. 
After  it  had  continued  an  hour  and  a  half,  the  ointment  was  applied, 
and  in  ten  minutes  she  was  much  relieved.  The  paroxysms  do  not 
now  last  more  than  twenty  minutes,  and  she  says  they  have  never 
been  so  slight  before. 

"6th.  The  pain  has  now  resumed  its  intermittent  character. 
On  the  3d,  5th,  and  7th,  she  had  a  short  and  slight  paroxysm  in  the 
evening  ;  each  being  less  severe  than  that  preceding  it. 

**  Quinse.  sulph.  gr.  v.  6  tis  horis. 

"9th.  The  pain  returns  every  other  night,  but  is  gradually  de- 
creasing in  duration  and  severity. 

"There  is  a  man  in  Luke's  Ward,  under  Dr.  Roots,  who  has  a 
painful  affection  of  the  sciatic  nerve,  for  which  he  used  Veratrine 
ointment  for  some  time  without  any  benefit.  He  has  used  the 
Aconitine  for  a  week,  and  a  very  decided  mitigation  of  the  pain 
followed  its  application. 

"  Dr.  Roots  informs  me  that  he  has  used  the  same  remedy  in 
private  practice,  in  three  cases,  with  similar  success." 

In  conclusion,  these  are  the  principal  circumstances  which  occur 
to  me  at  present,  as  worthy  of  mention  in  regard  to  this  new  class 
of  remedies.  The  facts  which  have  been  adduced,  appear  to  bear 
out  the  position  advanced  at  the  commencement — that  there  exists 
a  class  of  active  principles  in  the  Ranunculaceae  possessed  of 
similar  properties  when  applied  to  the  surface  of  the  skin,  and 
acting  in  a  similar  manner  in  the  same  diseases  ;  and  if  I  succeed  in 
calling  the  attention  of  the  profession  to  them  by  what  has  been 
stated,  my  object  in  making  this  communication  will  have  been 
answered. 


APPENDIX.  fly 


APPENDIX. 

CASES  COMMUNICATED  TO  THE  AUTHOR. 


Case  of  Tic- Douloureux  cured  by  Veratria  Ointment , communi- 
cated by  J.  Holme,  Esq.,  Surgeon,  Linton,  Cambridgeshire. 

Miss  L.,  a  young  lady  ten  years  of  age,  has  suffered  from  tic- 
doulot-reux  for  about  four  years.  In  the  winter  of  1829-30,  she 
first  complained  of  frequent  pains  in  the  face,  in  the  situation  of  the 
infra-orbitary  foramen,  attended  by  intermissions,  and  which  at 
first  were  considered  as  probably  connected  with  the  teeth.  In  the 
winter  of  1830-1831,  her  sufferings  became  much  greater  ;  and  on 
account  of  the  intermitting  nature  of  the  pain,  she  was  then  treated 
with  quinine  ;  but  having  experienced  no  relief  from  it,  she  had 
three  teeth  extracted,  yet  without  benefit.  During  the  summer  of 
this  year  (1831),  she  was  not  free  from  suffering,  especially  when 
exposed  to  chilly  weather  ;  and  if  she  happened  to  be  out  after  sun- 
set the  pain  was  brought  on. 

In  the  commencement  of  the  next  winter  I  first  saw  her  ;  at  that 
time  she  was  under  active  medical  treatment,  and  had  taken  carbonate 
of  iron,  arsenic,  morphia,  belladonna,  quinine  largely,  purgatives, 
mercury,  and  had  made  use  of  topical  applications,  but  all  without 
advantage.  The  paroxysms  of  pain  came  on  at  regular  periods,  two 
and  three  times  a-day,  for  the  space  of  from  t,wo  to  five  hours  at 
each  accession. 

In  February  1832,  she  was  taken  to  London,  and  put  under  the 
care  of  several  eminent  practitioners,  but  derived  no  benefit,  except 
for  three  weeks  in  July,  after  which  the  pain  returned  with  increased 
violence.  Baths  of  various  kinds  were  also  tried,  but  without  effect. 
She  returned  home,  and  six  weeks  since  the  Veratria  ointment  was 
first  tried,  and  in  about  five  days  she  experienced  much  relief. 
Within  that  time  she  had  no  attack  of  pain  during  the  night,  and  in 
three  days  more,  the  daily  paroxysms  nearly  ceased.  We  continued 
to  rub  the  ointment  for  about  twenty  minutes  before  the  expected 
time  of  the  attack,  and  in  one  day,  less  than  a  fortnight  from  begin- 
ning to  use  the  frictions,  all  recurrence  of  pain  had  left  her,  and  she 
now  continues  quite  free  from  any  inconvenience.  The  only  medi- 
cine she  took  during  the  use  of  the  ointment,  was  four  grains  of  pit. 
aloes  et  myrrhx,  at  bed-time. 

April  21, 1834. 
JANUARY,  1838.— G  7 


70  TURNBULL  ON  EANUNCULACE^E. 


Cases  in  ivhich  the  Veratria  Ointment  has  been  employed,  com- 
municated by  Edward  MacGowan,  Esq.,  M.D.,  Exeter. 

CASE  I. 

THE  first  case  happened  in  a  farmer,  about  thirty  years  of  age, 
who  had  been  many  weeks  suffering  from  severe  rheumatism  in  the 
articulations  generally,  but  especially  of  the  knees  and  feet.  He 
presented  the  rheumatic  diathesis  in  a  marked  degree,  and  there  was 
a  great  tendency  to  leuco-phlegmatic  anasarca.  1  gave  him  the  sub- 
carb.  ammon.  internally,  with  guaiacum,  and  ordered  frictions  on  the 
joints  to  be  made  with  the  ointment  of  Veratria.  In  the  course  of 
a  week,  he  rode  into  Exeter,  a  distance  of  five  miles,  and  told  me 
he  was  quite  recovered. 

To  my  surprise  the  swellings  and  pain  in  the  joints  had  subsided, 
and  the  general  health  was  much  restored.  He  had  been  almost  a 
cripple  previously  ;  and  has  not  had  since,  to  my  knowledge,  any 
return  of  his  former  complaint. 

CASE  II. 

AN  elderly  lady  of  gouty  diathesis,  and  subject  to  frequent  attacks 
of  gout  in  the  feet,  suffered  much  from  a  swelled  leg  and  foot,  which 
presented  an  appearance  precisely  similar  to  the  Barbadoes  leg. 
There  was  besides,  a  chronic  inflammation  in  the  toes  of  the  same 
limb,  around  the  nail  of  the  large  toe  particularly,  which  had  often 
been  attacked  by  gout,  and  which  was  accompanied  with  a  fungous 
kind  of  ulceration.  The  whole  limb  was  greatly  enlarged,  and  the 
cellular  tissue  extremely  hard,  with  now  and  then  an  erythematous 
inflammation  over  the  surface.  After  poppy-head  fomentations,  &c., 
J  used  the  Veratria  ointment,  which  reduced  the  swelling,  and 
abated  the  pain  beyond  my  hopes.  At  first  it  produced  a  slight 
irritation,  which  obliged  me  occasionally  to  suspend  the  frictions, 
but  that  was  the  only  inconvenience  that  resulted  from  it.  The 
limb  is  still  considerably  enlarged  but  much  reduced  and  less  pain- 
ful than  before,  which  1  certainly  think  is  owing  to  the  Veratria. 

I  have  some  other  instances  of  the  advantageous  exhibition  of 
Veratria  externally,  which  confirm  me  in  the  persuasion  of  its  effi- 
cacy in  rheumatic  and  gouty  swellings,  particularly  in  debilitated 
constitutions.  In  such  cases,  it  seems  to  stimulate  the  capillary  and 
absorbent  systems,  and  bring  back  a  vigorous  and  healthy  action. 

April  12th,  1834. 


Case  of  Tic-Douloureux  cured  by  Frictions  with  Veratria  Oint- 
ment, communicated  by  John  Spence,  Esq.,  Surgeon,  Otley, 
Yorkshire.  yv 

A  LADY,  about  twenty-four  years  of  age,  has  been  affected  for  the 
last  eight  or  ten  years  with  a  most  painful  neuralgic  affection,  situ- 


APPENDIX.  71 

ated  in  the  cheek  and  temple  of  the  right  side.  The  pain  makes 
its  appearance  in  regular  paroxysms,  varying  in  length  from  a  few 
days  to  several  weeks,  and  is  succeeded  by  intervals  of  partial 
relief.  The  state  of  the  patient  has  been  very  distressing,  and 
during  the  continuance  of  the  attack  her  sufferings  have  been  so 
extreme,  as  to  bring  her  into  a  condition  almost  bordering  on  dis- 
traction. 

Before  she  came  under  my  care,  she  had  been  treated  by  active 
depleting  measures  ;  she  had  been  bled  generally  and  locally,  and 
had  applied  topical  remedies  of  almost  every  description,  including 
repeated  blistering,  but  without  experiencing  any  cessation  of  the 
pain.  For  some  time  I  continued  a  similar  course  of  treatment, 
along  with  the  internal  administration  of  various  medicines,  none 
of  which,  however,  had  a  good  effect,  except  preparations  of  iron  ; 
these  succeeded  for  a  time  in  diminishing  the  severity  of  the  affec- 
tion, but  appeared  to  have  no  power  in  removing  it.  I  now 
ordered  the  patient  to  rub  the  affected  part  of  the  face,  for  twenty 
minutes,  with  a  portion  of  ointment  made  with  a  scruple  of  Vera- 
tria  to  one  ounce  of  lard,  when  the  paroxysm  came  on.  Next  time 
I  saw  her,  she  told  me  that  when  the  pain  made  its  appearance,  she 
applied  the  ointment  as  directed,  and  that  the  attack  was  cut  short 
immediately.  After  this  period  the  paroxysms  returned  two  or 
three  times  ;  but  were  removed  by  the  same  means.  I  saw  her  a 
day  or  two  ago  ;  she  was  quite  well,  and  is  now  free  from  the 
disease. 

June  10th,  1834. 


Notices  of  Cases  in  which  the  Veratria  Ointment  has  been  em- 
ployed, communicated  by  S.  Hood,  Esq.,  M.  Z).,  Brighton. 

THE  first  case  in  which  I  tried  Veratrine,  was  in  that  of  a  lady 
who  had  laboured  some  considerable  time  under  tic-douloureux, 
seated  in  the  second  branch  of  the  fifth  pair  of  nerves,  on  the  left 
side  of  the  face.  Many  remedies  had  been  previously  tried  without 
effect,  and  it  was  at  last  determined  upon  to  attempt  the  removal  of 
the  pain  by  means  of  friction  over  the  affected  part  with  the  Vera- 
trine ointment  of  the  usual  strength.  After  this  treatment  had  been 
continued  for  three  days,  the  disease  was  apparently  cured,  but 
again  returned  with  considerable  violence  ;  the  ointment  was  again 
had  recourse  to,  and  the  patient  is  now  quite  well.  It  may  be  pro- 
per to  state  that  latterly  she  had  been  in  the  habit  of  taking  three 
grains  of  sulphate  of  quinine  a-day  ;  I  do  not  think,  however,  from 
previous  trials  of  it  in  this  case,  that  it  would  have  been  of  the  least 
benefit  without  the  ointment. 

In  two  other  cases  of  tic-douloureux,  in  the  first  branch  of  the 
fifth  pair,  the  Veratrine  was  most  efficacious  :  in  one,  the  disease 
was  removed  by  it  in  a  single  night ;  the  other  was  relieved  on  the 


72  TURNBULL  ON  RANUNCULACE^E. 

third  day  after  the  first  application  of  the  ointment ;  there  was, 
however,  a  relapse  in  about  a  week  afterwards,  but  the  pain  was 
again  removed  by  the  friction,  and  the  patient  is  now  quite  well. 

In  addition  to  these,  I  have  prescribed  the  Veratrine  ointment  in 
three  cases  of  painful  affections  in  the  course  of  the  sciatic  nerve  ; 
they  went  on  gradually  improving  and  are  now  removed. 

About  the  diuretic  effects  of  the  Veratria  there  can  be  no  doubt ; 
in  every  instance  in  which  I  have  employed  it,  the  application  has 
been  followed  by  an  increased  discharge  of  straw-coloured  urine. 
In  dropsical  cases  occurring  in  old  persons,  after  the  diuretics  in 
common  use  have  been  carried  as  far  as  the  stomach  can  bear  them, 
it  will  be  of  great  utility  while  the  use  of  internal  remedies  is 
suspended.  I  have  three  such  cases  at  present  under  its  influence, 
and  all  of  them  are  going  on  favourably,  and  likely  to  terminate 
well. 

April  27th,  1834. 


Case  illustrative  of  the  effect  of  Frictions  with  Veratria  Oint- 
ment in  Palpitation,  communicated  by  William  Porter, 
Esq.,  Surgeon,  Gower  Street. 

A  LADY,  about  twenty-eight  years  of  age,  has  suffered  from  a 
dropsical  affection  for  about  eighteen  months,  accompanied  with  a 
considerable  degree  of  palpitation  of  the  heart  and  irregularity  of 
the  pulse,  and  these  symptoms  appeared  to  be  connected  with  irre- 
gular menstruation,  from  which  the  patient  had  suffered  for  some 
time.  The  lower  extremities  were  oedematous,  and  there  was  dif- 
ficulty of  respiration  and  general  nervous  excitement.  In  the 
treatment  of  the  disease  various  measures  were  employed  without 
much  benefit,  until  about  two  months  ago,  when  the  oedematous 
state  of  the  extremities  was  much  relieved  by  the  use  of  diuretics 
and  drastic  purgatives  ;  the  palpitation,  however,  continued  the 
same  as  before.  As  this  latter  symptom  was  peculiarly  annoying 
to  the  patient,  the  attempt  was  made  to  remove  it  by  means  of  an 
ointment  made  with  twenty  grains  of  Veratria  to  one  drachm  of 
lard,  and  a  small  part  of  this  was  ordered  to  be  rubbed  over  the 
region  of  the  heart  for  ten  minutes  night  and  morning.  After  the 
second  or  third  friction  the  palpitation  disappeared  along  with  the 
irregularity  in  the  pulse  ;  this  took  place  about  eight  weeks  ago, 
and  although  the  patient  is  still  unwell,  it  has  not  returned. 

June  20th,  1835.  \  -^ 


THE  END. 


